1: Health and Safety, Occupational Hazards and Infection Control in the Dental Workplace

CHAPTER 1 Health and Safety, Occupational Hazards and Infection Control in the Dental Workplace

Health and safety: general considerations

It is essential that dental nurses are aware of the hazards in the dental workplace and the health and safety actions that you can take to avoid harm. Human error is responsible for most risks in a workplace.

In the UK:

Health and Safety at Work etc. Act 1974

The Health and Safety at Work etc. Act 1974 applies to all workplace premises, including dental surgeries. It makes it clear that all employers are responsible not only for the health and safety of their staff but also of anyone who might be on their premises, such as patients or suppliers. All staff and visitors to a workplace should also act in a responsible manner and prevent any hazards occurring that may cause injury to themselves or others.

In addition to the Health and Safety at Work etc. Act 1974, the Dentists Act 1984 makes the employing dentist accountable for all faults or omissions made by their staff (including dental nurses).

The employer’s responsibilities

Every employer should:

Maintain the workplace (see Box 1.1.1), equipment and all work appliances in a safe condition

Usually the employer will have liability insurance to cover any injury that occurs on the premises to either staff or visitors (e.g. patients and their accompanying people, contractors etc.).

Risk assessment

A risk assessment is simply a careful examination of what, in the workplace, could cause harm to people. Doing a risk assessment helps employers decide whether they have taken enough precautions, or should do more, to prevent harm from occurring to themselves, their staff or others.

A risk assessment should:

Occupational hazards related to dentistry

Generally the risk of hazards occurring in the surgery are very low nowadays because of regulation and enforcement of good work practices by government authorities such as the HSE.

Most dental staff are in good general health. The more important concerns in the dental workplace are:

Government regulations are in place concerning most of the above. The following sections explain how, as a dental nurse, you can reduce the risks by following the regulations.

Accidents

Legislation applying:

Accidents occur in most workplaces, and dental premises are no exception. Accidents are more likely to happen when staff are not concentrating on their activities or are distracted. Obvious physical dangers to patients, staff and others include:

The hands and eyes are especially vulnerable when caustic fluids, needles, scalpels, wires or lasers, hot or rotating instruments are used. Risks related to the use of needles are explained in more detail in the section on ‘Infections and inoculation injuries’ (p. 14).

Recording and notifying accidents

All accidents and injuries to staff or patients or visitors while on the premises, however apparently trivial, should be recorded in an accident book. Her Majesty’s Stationery Office (HMSO) publishes an ‘Accident Book’, which is suitable for use in the dental environment.

Employers must notify the HSE of accidents causing death or ‘major injury’ to any person or ‘dangerous occurrences’, even if there has been no death or injury. They also have to keep records of the event.

Under the regulation called RIDDOR, any injury occurring in a workplace should be reported if the person:

or

or if the injury involves any of the following:

Thus, for example, in the dental practice, a compressor or steam steriliser (autoclave) explosion could be notifiable, as could a mercury spillage. In case of doubt of whether an injury should be reported, the advice of the local HSE office should be sought.

Reports related to RIDDOR should be immediately given by telephone to HSE, and a completed accident report form (2508) sent to the HSE within 10 days. Incident reporting forms can be downloaded from the HSE website (www.hse.gov.uk/forms/incident/f2508.pdf) or obtained from The Stationery Office Bookshop (www.tso.co.uk/contact). A copy of the completed 2508 form should also be kept by the employer.

If the incident does not result in a reportable injury but clearly could have done so, it is classed as a dangerous occurrence and must also be reported immediately by completing form 2508. A full list of what are ‘dangerous occurrences’ and the employer’s responsibilities are given in the RIDDOR 97 leaflet. (A needlestick injury (p. 14), involving an infected patient may also fall in this category.)

Reporting diseases under riddor

If the employer is notified by a doctor that an employee has a reportable work-related disease or infection (e.g. occupational dermatitis, occupational asthma, tuberculosis, hepatitis B, legionnaires’ disease), the HSE must be sent a completed disease report form (2508A; available at: www.hse.gov.uk/forms/incident/f2508a.pdf).

Find Out More

Of the responsibilities listed in Box 1.1.2 which would be the dental nurse’s responsibilities? Make a list and get your supervisor to comment on it.

Allergies

Allergic reactions are common and usually minor but some are potentially lethal. People with asthma, eczema and some other conditions often have underlying allergies. Sometimes allergic reactions can be very severe (called anaphylaxis; see Chapter 2).

Many allergies have a hereditary component but the prevalence of allergies appears to be increasing. Table 1.1.1 lists some common allergens.

TABLE 1.1.1 Common Allergens

Source of Allergen Examples
Food products Milk, nuts, egg, shellfish
Drugs Aspirin, penicillins,
Environmental Animal hair, dust mite, pollen
Latex Condoms, elastic bands, gloves
Dental materials Amalgam alloy, gold, mercury, resin-based materials

Latex allergy

Latex allergy has become a significant clinical problem, along with allergies to iodine, plasters (e.g. Elastoplast and Band-aid) and drugs (remember this with the acronym LIED – Latex Iodine Elastoplast Drugs). Latex products are common in the home and workplace including clinics, wards and operating theatres. Therefore allergy is an important occupational problem, especially with handwashing using abrasive materials, which increases the risk of sensitisation. Allergic reactions to latex have become increasingly common since the use of protective medical/dental gloves became mandatory following the advent of HIV/AIDS. Latex exposure may occur via the skin, mucous membranes, or respiratory tract (see Subchapter 4.1) with inhalation of latex glove powder (natural rubber latex (NRL) allergens may attach to lubricating powder, and become aerosolised, causing sensitisation; or, in those who are allergic, they can cause respiratory, ocular or nasal symptoms).

‘Low-allergen’ latex gloves are available but there is little certainty that these offer any real benefit. People who have allergies to one type of substance are more likely to have allergies to others; patients with latex allergy, for example, may react to foods with allergen cross-reactivity such as avocado, banana, chestnut and kiwi.

Many items used in dental practice can sometimes contain latex (Box 1.1.3) and even equipment and laboratory work previously handled with latex gloves may elicit an allergic response.

Diagnosis of an allergy is based on:

To avoid future allergic reactions, known allergens should be avoided, which is easier said than done. This is because sensitive individuals may react to minute traces of an allergen, and because allergens can be present in the most unexpected places.

Patients who have had serious allergic reactions such as anaphylaxis (see Chapter 2) are also usually advised to always carry with them adrenaline for subcutaneous self-injection in the event of a reaction (e.g. Epipen). Affected individuals are usually advised to wear a warning emblem such as Medic-Alert.

Treatments for allergies include use of various drugs such as antihistamines.

Burns

Burns can result from chemical (acids) or physical agents (heat, cold, radiation such as X-rays or lasers).

Chemicals (Hazardous Substances)

Legislation applying:

All dental surgeries and laboratories must undertake risk assessments of all chemical and potentially hazardous substances used in the premises. The results of the assessments must be recorded in a COSHH report. The report must include:

Hazardous materials in general include:

Hazardous materials in dentistry include:

Employers are required to:

Gases and volatile liquids

A dental nurse may be exposed to anaesthetic gases (nitrous oxide) and vapours for a significant part of their career if the equipment used to administer the gases is faulty, poorly maintained or used without an effective scavenging system, or if the agents are misused. These gases, which are also called inhalational agents, are used in conscious sedation (nitrous oxide) and general anaesthesia (nitrous oxide, isoflurane, enflurane, sevoflurane and desflurane; halothane is no longer commonly used – see below). Anaesthesia is covered in detail in Chapter 13.

Under normal working conditions, our mental and nervous responses, that is, how alert we are and how quickly and appropriately we react to situations, are not much impaired by exposure to inhalational agents. However, if a clinician is exposed to excessive amounts of these gases or over a long period of time, not surprisingly, their responses can be impaired. They may also develop numbness, difficulty in concentrating, paraesthesias (‘pins and needles’) and dizziness. Nitrous oxide exposure for prolonged periods can also have adverse effects on other organs of the body, for example the heart, liver and bone marrow, and the reproductive organs.

Halothane and some other halogenated inhalational agents (sevoflurane and desflurane) can cause severe liver dysfunction (called hepatotoxicity) and problems with the beating of the heart (called arrhythmias). Therefore halothane is no longer recommended for use in adults. Only occasional hepatotoxicity has been reported with enflurane and isoflurane.

Clearly, all dental practices should take steps to control and minimise the exposure to inhalational agents (see Box 1.1.4).

Eye Hazards

Eyes need protection from foreign bodies, infected material, chemicals and the various forms of radiation used in dentistry – lasers, light sources for curing (ultra-violet/visible blue or white halogen light) and X-rays. These are covered in more detail on page 16.

Fires and Explosions

Legislation applying:

Human error is responsible for most fires and explosions. The main causes of fire in a dental practice or similar place usually are: electrical faults (see p. 12); careless use of matches; incorrect use of flammable gases (e.g. oxygen) and fluids; and non-electrical heating.

A commonsense approach, particularly avoiding the use of naked flames and taking care in the use and storage of flammable materials, will prevent many problems. For example:

Employer and employee responsibilities

Employers must comply with fire safety regulations. This means carrying out a fire risk assessment to determine what precautions are needed and putting in place fire precaution measures. If there are five or more employees, the fire risk assessment must be written down.

Infections and Inoculation Injuries

Dental staff are commonly exposed to respiratory infections, mainly ‘colds’, and other viral throat and chest (respiratory) infections. Other more serious respiratory hazards are ‘flu’ (influenza), tuberculosis (TB) and, to a much lesser extent, Legionella infection (also called legionnaires’ disease). All these infections could also be transmitted to patients or others (see Subchapter 1.2).

The main infectious hazard in the dental practice is contact with infected body fluids (blood, saliva, etc.). Infections can be transmitted via sharps injuries (needlestick injury; inoculation, particularly those caused by viruses such as hepatitis B, hepatitis C and human immunodeficiency virus (HIV). Prions, which cause Creutzfeldt–Jakob disease (CJD), are virtually impossible to destroy. MRSA (meticillin-resistant Staphylococcus aureus) infection is mainly a healthcare-associated infection (HCAI).

Jan 8, 2015 | Posted by in Dental Nursing and Assisting | Comments Off on 1: Health and Safety, Occupational Hazards and Infection Control in the Dental Workplace
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