National Handwashing Week: Dec. 2 - 8

December 2 – 8 is National Handwashing Awareness Week. Keeping hands clean is one of the most important ways to prevent the spread of infection and illness.

Wash Your Hands: The Right Way:

When washing hands with soap and water:

• Wet your hands with clean running water and apply soap. Use warm water if it is available.
• Rub hands together to make a lather and scrub all surfaces.
• Continue rubbing hands for 15-20 seconds. Need a timer? Imagine singing "Happy Birthday" twice through to a friend.
• Rinse hands well under running water.
• Dry your hands using a paper towel or air dryer. If possible, use your paper towel to turn off the faucet.
If soap and clean water are not available, use an alcohol-based hand rub to clean your hands. Alcohol-based hand rubs significantly reduce the number of germs on skin and are fast acting.

When using an alcohol-based hand sanitizer:

• Apply product to the palm of one hand.
• Rub hands together.
• Rub the product over all surfaces of hands and fingers until hands are dry.

World AIDS Day

World AIDS Day --- December 1, 2007

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5647a1.htm?s_cid=mm5647a1_e%0A

December 1 marks the 20th observance of World AIDS Day, an annual worldwide event established to increase awareness and education regarding human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS). In 2007, an estimated 33.2 million persons worldwide are living with HIV; the number of deaths from AIDSin 2007 is expected to total 2.1 million (1). In the United States, an estimated 1 million persons were living with HIV in 2003 (2); of these, approximately 25% were unaware of their infection and thus were at high risk for infecting others.

HIV testing remains a crucial component of HIV prevention strategies. Persons who know they are infected with HIV can seek health care and protect their partners from becoming infected. In 2006, CDC issued newguidelines recommending routine HIV testing of adults, adolescents,and pregnant women in health-care settings in the United States (3). In addition, CDC recently provided funding to increase testing among populations disproportionately affected by HIV/AIDS. Additional information regarding World AIDS Day and HIV prevention measures isavailable at
http://www.cdc.gov/features/worldaidsday and http://www.cdc.gov/hiv.

New NIOSH Blog

The National Institute for Occupational Safety and Health (NIOSH) introduced a new NIOSH Science Blog on Nov. 5, 2007, to further communicate the scientific issues related to NIOSH's research and recommendations, and to stimulate discussion on those issues.

The blog or web log at http://www.cdc.gov/niosh/blog/ is intended as a new way to help NIOSH fulfill its mission of translating research into practice for preventing work-related injuries, illnesses, and deaths. It is designed to provide an expeditious system for partners and stakeholders to present ideas to NIOSH scientists and each other, while engaging in robust scientific discussion with the goal of protecting workers.

MRSA in the Workplace

NIOSH has posted a new web page with information and recommendationsto help employers and workers address workplace concerns associated with MRSA.

http://www.cdc.gov/niosh/topics/mrsa/

Posted as a resource for employers and workers who may be looking forinformation that can be applied to workplaces other than health-carefacilities, which are already included under general CDC infection-control guidelines.

Needlestick Brochure

The Premier Safety Institute developed a brochure to educate healthcare and public health and safety workers in any setting across the continuum of care about the serious risks of occupational needlestick injuries and strategies and devices to reduce risks. The settings where needlestick injuries may occur include ambulatory settings, physicians' offices, ambulances, nursing homes, skilled nursing facilities, home health care, assisted living, or hospitals.

Download copy of brochure
Needlestick prevention brochure (.pdf) (925 KB)

The 12-page, easy-to-read brochure has information about:
How needlesticks happen
Why needlesticks are stressful to you and your family
What work practices can protect you
What the laws are for using safety devices
How to evaluate safety devices
How to dispose of sharps safely
What to do if you are injured

Labor Day Message

As the President said today, "On Labor Day, we honor the hard work and dedication of the men and women of our workforce. Their efforts contribute to the prosperity of our great Nation". We at Dynamic Dental Safety would like to echo those sediments and especially thank dental and all other healthcare professionals for their hard work, dedication and compassion to their patients.

Need a Flu Shot Reminder?

Flu season is just around the corner… The Centers for Disease Control has determined that vaccinations are the single most effective way to prevent flu and strongly encourages high-risk individuals (including health care providers) to get vaccinated. From a public health prospective, it is recommended that you encourage your office staff and high-risk patients to get an annual Flu shot.

This includes individuals who are:

-- Anyone who wants to reduce the likelihood of becoming ill or spreading influenza to others

-- All persons over 50 years old

-- Children and adolescents who are receiving long-term aspirin therapy

-- Women who will be pregnant during the influenza season

-- Adults and children who have chronic pulmonary (including asthma), cardiovascular (except hypertension), renal, hepatic, hematological or metabolic disorders (including diabetes mellitus)

-- Adults and children who have a weakened immune system (due to: HIV/AIDS, long term treatment with drugs such as steroids, cancer treatments)

-- Adults and children who have certain muscle or nerve disorders (e.g., cognitive dysfunction, spinal cord injuries, seizure disorders, or other neuromuscular disorders) that can compromise respiratory function or the handling of respiratory secretions or that can increase the risk for aspiration; and

-- Residents of nursing homes and other chronic-care facilities

- Anyone who lives or cares for people at high risk for influenza related complications

-- Health care providers

-- Household contacts and caregivers of children from birth to 5 years of age and adults age 50 and older.

-- All children aged 6-59 months

See http://www.FindaFluShot.com to schedule a reminder to insure you are alerted to find a convenient location to obtain your immunization this coming flu season.

North American Pandemic Influenza Plan

Leaders of Canada, Mexico, and the United States who met at a security summit in Montebello, Quebec, on Aug 21 unveiled a North American pandemic influenza plan designed to share expertise, coordinate public health messages, and overcome anticipated obstacles at national borders.

The North American Plan will enhance collaboration in order to: detect, contain and control an avian influenza outbreak and prevent transmission to humans; prevent or slow the entry of a novel strain of human influenza to North America; minimize illness and deaths; and sustain infrastructure and mitigate the impact to the economy and the functioning of society.

Maintaining critical infrastructure and services will be essential during a pandemic. While influenza cannot physically damage critical infrastructure, a pandemic could weaken it by diverting essential resources or removing essential personnel from the workplace. This Plan, therefore, extends beyond the health sector to include a coordinated approach to critical infrastructure protection, including the importance of business con­tinuity planning and recognition of interdependencies among sectors.

The full Plan is available at http://www.state.gov/g/avianflu/91246.htm

Please contact Dynamic Dental Safety (888-669-8846 x701) for assistance in developing your own business continuity plan for all emergencies.

Hepatitis B Vaccination Declination Form

Q. If an employee who handles blood as part of their job is offered the hepatitis B vaccine, but refuses it... what paper work is required?

A. Below is an example of a declination statement which should be signed/dated by the employee and kept on file in the office.

“ I understand that due to my occupational exposure to blood and/or other potentially infectious body fluids, I may be at risk of acquiring hepatitis B virus (HBV) infection. I have been given the opportunity to be vaccinated with hepatitis B vaccine at no cost to myself. However, I decline the hepatitis B vaccine at this time. I understand that by declining this vaccine, I continue to be at risk of acquiring hepatitis B which is a serious disease. If in the future I continue to have occupational exposure to blood and/or other potentially infectious body fluids and I want to be vaccinated with the hepatitis B vaccine, I can receive the vaccination at no cost to me.”

OSHA Offers New Health Care Compliance Assistance Module

OSHA added a Health Care module to its Compliance Assistance Quick Start tool-the online guide to free compliance assistance resources on OSHA's Web site. The module is designed to help employers understand OSHA regulations applicable to the healthcare industry, including recordkeeping, reporting and posting requirements. It also contains information on developing a comprehensive safety and health program and on training employees.

Please contact Dynamic Dental Safety (888-669-8846, x701) for cost-effective assistance in developing your office safety program, including on-site training for your staff with continuing education credits.

Blood Exposures with Unknown Source

Q. How are exposures to blood from a patient whose infection status is unknown handled?

A. If the source patient cannot be identified (e.g. exposure when disinfecting equipment) or refused to be tested (does not give informed consent), decisions regarding follow-up should be based on exposure risk and whether the source is likely to be infected with a bloodborne pathogen. Follow-up testing should be available to all personnel who are concerned about possible infection through occupational exposure.

Dynamic Dental Safety is available for blood exposure consultations, please call (888) 669-8846, x 701

MSDS

Q. How long do I need to keep a MSDS after we discontinue use of the product?

A. Employee exposure records, which include MSDS or an inventory of the MSDS that an employee may have been exposed to, must be kept for 30 years after an employee leaves the organization.

As this can lead to a very thick MSDS manual, dds recommends that MSDSs of discontinued products in the office be placed in a separate archive file.

Eye Protection

Ocular injuries may have serious and long term effects. Symptoms of direct mechanical trauma often relate to the degree and type of trauma, and include pain, lacrimation, and blurring of vision. Penetrating ocular trauma often causes visual damage and may require extensive surgery. Bacterial, viral and chemical exposures can result in long term visual impairment and discomfort, which may limit a practitioner's future clinical practice.

Operators and close support clinical staff must protect their eyes against foreign bodies, splatter and aerosols that may arise during operative dentistry:

During scaling, (manual and ultrasonic)
Using rotary instruments
Cutting and use of wires
Cleaning instruments.

Ideally protective glasses should have side protection. Patients' eyes must always be protected against possible injury; tinted glasses may also protect against glare from the operating light.

Reference: Infection control in dentistry. BDA Advice Sheet A12. Feb 2003

Construction Issues

An office exhibiting the picture to the right during operational hours is not in compliance with the electrical standards of not only OSHA........ but those of most localities as well. In addition this condition shown above may pose a serious threat to not only employees, but patients and visitors as well.

We know that our contractors ideally should take care of these situations as part of their completion of the project. However, we at Dynamic Dental Safety are seeing an increasing number of these situations in existing operational dental facilities. Please note that "ignorance is not a defense" in an office ........ and the liabilities are enormous.

It is imperative that each and every "team member" be empowered with bringing any and all safety issues to the correct person in the dental office. Additionally, a third party evaluation of the facility is almost always a benefit to the office.

Dynamic Dental Safety performs this service and all other compliance issues for the dental office. Please contact us at (888) 669-8846 ext. 701 for information on our comprehensive services for your dental office.

Dental Records

The dental record/chart is an official document. As such attention to detail is vital in all aspects of this document. Part of the "due diligence" for each and every dental office should be the monitoring and auditing of these documents. Of particular importance is the medical history of the patient. This should always be reviewed with the patient orally and signed by the reviewer.

Dynamic Dental Safety can assist the office with the "auditing form" that should be employed to ensure full compliance with your State Board of Registration as well as many of the insurers.
Please contact us at (888) 669-8846 ext. 701 for further information with regard to compliance issues in the dental office.

Ceiling Tiles

As we can all see, the picture to the right is not a pretty one. With the inordinate amount of plumbing necessary to operate a dental office, there can be times when a pipe or connection fails. Either this or some weather event may cause damage to the dental office.

When ceiling tiles become saturated with water they pose serious issues on multiple levels. Firstly, due to the weight of the water, the tile or tiles can become quite heavy and eventually may break and injure either an employee or visitor to the dental office.

Past this, when the immediate problem is "contained", the issue then may become one of air quality. In the above picture, the recommendation to the dental office was to replace the affected tiles due to appearance and potential for mold growth. This potential additionally could pose long term liabilities for the owner of the dental office as welll as open the office up to the visitation by the regulatory agencies.

Dynamic Dental Safety addresses all forms of compliance issues for the dental office. Please contact us for information on our cost effective programs for your office at:

(888) 669-8846 ext. 701

What's in Your Biohazard Box?

This is a biohazard box from a dental facility that was reviewed by Dynamic Dental Safety. Many of you may note that there are items in this double corrugated box that are at the very least unnecessary in most states. This only adds to the expense of the dental office and additionally needlessly overfills our landfills.

Please note that it is important to dispose of any and all "biohazardous" materials with appropriate care. It is also important to review your state and local regulations with respect to these items and their proper disposal and recordkeeping.

Dynamic Dental Safety assists dental offices with all compliance regualtions for state specific guidelines as well as OSHA and CDC standards. Please contact us for any compliance questions and solutions at: (888) 669-8846 ext. 701

Eyewash........ more information

We at Dynamic Dental Safety have addressed the eyewash station in a number of blogs to date. Location, usage, and documentation of monitoring of this device are essential for all staff to exhibit their knowledge.

Now, a situation that has presented itself on numerous occasions, we feel is important to address for each and every dental office. Due to our labor and work situations, we in the dental field are sometimes confronted with the need to employ a "temp" in our office. This may seem like an innocuous situation, however, it may pose some serious liability for our dental office.

Take for example the "temp" who might accidentally have something affect his or her eye(s). If we at the dental office did not take the time to "show" this individual where the eyewash was located and how to operate it........ and further to document this ....... we might be assuming untold liability.

For assistance with this or any other compliance issue facing the dental office, please contact us a Dynamic Dental Safety for our cost effective solutions for your dental office at:

(888) 669-8846 ext. 701

Location of Emergency Eye Wash Stations

Q. Where should the emergency eye wash station be located?

A. To be effective, the equipment has to be accessible. The American National Standards Institute (ANSI) recommends that a person be able to reach the equipment in no more than 10 seconds. In practical terms, consider that the person who needs the equipment will be injured, and may not have use of their vision. Recommendations for this distance in linear terms range from 15 to 30 meters (50 to 100 feet).

Other recommendations include that the eyewash station should:

- be located as close to the hazard as possible
- not be separated by a partition from the hazardous work area.
- be on an unobstructed path between the workstation and the hazard. (Workers should not - have to pass through doorways or weave through machinery or other obstacles to reach them.)
- be located where workers can easily see them - preferably in a normal traffic pattern.
- be on the same floor as the hazard (no stairs to travel between the workstation and the emergency equipment)
- not come into contact with any electrical equipment that may become a hazard when wet.

Reference: Canadian Centre for Occupational Health & Safety

Digital X-Rays and Lead Aprons

Q. Our office has switched to digital x-rays... do we still need to place lead aprons and thyroid collars on our patients?

A. From a scientific standpoint, the answer is esstentially no. From a risk management standpoint, the anwer is yes.

Many years ago, dental x-ray equipment was a lot less sophisticated than it is today. Not only that, the type of film used was much slower than that in use now, and a LOT slower than the new digital x-rays. Depending on instrument settings, digital x-rays may have lower amounts of radiation emitted. Overall, the technological improvements in equipment, film types and data processing in use today have pretty much eliminated the need for leaded aprons.

However, patients often expect to have an apron placed over them during their procedures, just because they were used to seeing them in the past. In addition, it is conceivable that a patient could subsequently claim (perhaps many years after their treatment) that a medical issue they have is as a result of radiation exposure. So, from a risk management standpoint, it would be best to continue to use lead chest aprons and thyroid collars when using both traditional and digital x-ray systems.

Contaminated Toothpaste from China

The US Food and Drug Administration (FDA) has found a poisonous chemical, diethylene glycol (DEG), in certain toothpastes imported from China. DEG is used in antifreeze and as a solvent. The agency increased its scrutiny and testing of imported toothpaste and dental products after receiving reports in late May 2007 of contaminated Chinese dental products found in several countries, including Panama.

The agency is warning consumers to avoid using tubes of toothpaste labeled as made in China and, through an import alert, is stopping all suspect toothpaste from entering the United States. FDA continues to investigate this problem and will take further action, as appropriate, to address this important public safety issue.

FDA is not aware of any U.S. reports of poisonings from toothpaste containing DEG. However, the agency is concerned about potential risks from chronic exposure to DEG and exposure to DEG in certain populations, such as children and individuals with kidney or liver disease. DEG in toothpaste has a low but meaningful risk of toxicity and injury to these populations. Toothpaste is not intended to be swallowed, but FDA is concerned about unintentional swallowing or ingestion of toothpaste containing DEG.

What to Avoid:
- Products labeled “made in China”
- Counterfeit toothpaste falsely packaged as "Colgate," manufactured in South Africa
- Packages labeled in a language other than English

Frequently Asked Questions About the Contaminated Toothpaste from China. (En Español)

HIPAA Tips

Q. Will sending appointment reminder postcards violate HIPAA?

A. It is A-OK to send an appointment reminder card which simply states the date/time of the appointment. However, confidentiality would be violated if you provide both the patient's name and reason for the visit (e.g. Mr. Jones, this is a reminder of your July 17, 2007 appointment for your crown).

Storage and Dispensing of Hand Care Products

Handwashing products, including plain (i.e., nonantimicrobial) soap and antiseptic products, can become contaminated or support the growth of microorganisms. Liquid products should be stored in closed containers and dispensed from either disposable containers or containers that are washed and dried thoroughly before refilling. Soap should not be added to a partially empty dispenser, because this practice of topping off might lead to bacterial contamination. Store and dispense products according to manufacturers’ directions.

Ref. CDC Guidelines for Infection Control in Dental Health-Care Settings — 2003

Stress at Work

Working conditions play a primary role in causing job stress. However, the role of individual factors is not ignored. According to the NIOSH view, exposure to stressful working conditions (called job stressors) can have a direct influence on worker safety and health. Examples of individual and situational factors that can help to reduce the effects of stressful working conditions include the following:

- Balance between work and family or personal life
- A support network of friends and coworkers
- A relaxed and positive outlook

Ref. Stress at Work - NIOSH Publication No. 99-101:

Dental Ergonomic Risk Factors and Control Measures

Significant ergonomic risk factors for dentists are static loading of the neck (prolonged focus on small areas inside the patient’s oral cavity) and static loading and awkward postures of the hands (anesthetic injection and drilling of patient’s teeth).

Sigificant ergonomic risk factors for dental assistants are twisting and turning of the back, and extended reaches of the arms to access dental instruments, prolonged static postures, forceful exertions of the hands while using dental instruments, and carving fillings.

Control measures include, but are not limited to:

- Replace older rear delivery equipment with more modern “continental-style” over-the-patient equipment. Utilize patient chairs that are as thin as possible.

- Ensure that existing equipment is functioning properly and that all chairs are able to be raised and lowered within the range for which they were designed.

-Design operatories so that the assistant or dentist does not have to get up or twist to use an amalgamator or curing light.

- Practice good posture while treating dental patients.

- Utilize slow set amalgams when doing large fillings.

Ref. NIOSH: HETA 98-0032-2795, Indian Health Service Dental Clinics, Arizona

Controll Exposures to Nitrous Oxide during Anesthetic Administration

Nitrous oxide may cause decreases in mental preformance, audiovisual ability and manual dexterity and adverse reproductive effects. Prevent leakage from the anesthetic delivery system through proper maintenance and inspection of equipment.

Eliminate or replace the following:
- Loose-fitting connections
- loosely assembled or deformed slip joints and threaded connections
- Defective or worn seals, gaskets, breathing bags, and hoses

Control waste nitrous oxide with a well- designed scavenging system that includes the following:
- Securely fitting masks
- Sufficient flow rates for the exhaust
- Properly vented vacuum pumps

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

Remove Those Rings

Q. Must I remove rings before putting on exam gloves?

A. Whether wearing rings increases the likelihood of transmitting a pathogen is unknown; further studies are needed to establish whether rings result in higher transmission of pathogens in health-care settings. However, rings and decorative nail jewelry can make donning gloves more difficult and cause gloves to tear more readily. Thus, our recommendation is to remove jewelry so that it does not interfere with glove use (e.g., impair ability to wear the correct-sized glove or alter glove integrity).

Ref. CDC Guidelines for Infection Control in Dental Health-Care Settings — 2003

Autoclaves........ and more

Please do not be put off by the sign at the left ... it may seem insulting, however, many of us are on such a tight schedule and under heavy pressure to produce that we try to "push the limits" of not only ourselves..... but our trusted machinery.

One of the items that we so often take for granted is our sterilizer. In many of the dental offices that we visit, the primary sterilizer is an autoclave. Most of the dental offices use these machines in the proper way. Some, due to scheduling issues, growth in the practice and for a variety of other reasons, abuse the machine and this can cause a multitude of problems for the office. A not so pretty picture of this occured at an office that we at Dynamic Dental Safety visited some time ago.

The picture that we see below is not very attractive......... in fact it did lead to a subsequent failure in the process. In short .... it created havoc in the office.

We cannot emphasize enough that proper training, accountability and documentation of compliance procedures can be implemented to avoid issues like this.

Please contact us at Dynamic Dental Safety for questions and answers to this or any other compliance issue that you may have in your dental office. We can be reached at (888) 669-8846 ext. 701

Burs......... What to do?

Upon entering the operatory as a patient I might see the image at the right. A number of questions might enter my thoughts as I see this scenario...........

1. What are all of those things on the table?


2. Should the instrument (pliers) be just left out as they are?


3. Those little drills ........ are they going to go into my mouth?......... and more important.. are they sterile?

In fact, patients might think all of these things and more!!!!!!! In today's world, many of the patients will be confident enough to ask us their questions. However, there are some who might in fact not volunteer the questions and might take these to the next level.

The level that the patients most often go is their state dental board. We at Dynamic Dental Safety have seen an alarming increase in reports of Infection Control lapses coming to state dental boards. It is therefore imperative to both view your facility from the eyes of the patient and ensure that all of your compliance mandates are in place.

For help with this or any compliance questions please contact Dynamic Dental Safety at (888) 669-8846 ext. 701

Sterilization Packaging

After we run our sterilizer through its cycle, and we remove the packaged instruments from the interior....... we should notice that there is a color change evident somewhere on the packaging material. It is either a word or an arrow or some indication. What exactly does this mean??? In many of the dental offices that we visit, the impression from the employees is that they think that this means that the instruments in the packet are sterile.

In fact, the color change is only measuring one of the necessary parameters for sterilization. In most cases this is only measuring that the heat or temperature has reached the desired level for the appropriate amount of time. For dental and medical procedures we need both the temperature and a sufficient pressure for a period of time to effect a proper sterilization.

This can only be measure by some form of spore testing. Please note that there are specific federal and state guidelines for the documetation and frequency of spore testing.

Please contact us at Dynamic Dental Safety for some of the specifics in the requirements for compliance for your area at (888) 669-8846 ext. 701

Watch Your Skin!

Percutaneous injuries (e.g. needlesticks and other “sharps” injuries) are among the most efficient modes of transmission of bloodborne pathogens (hepatitis B, hepatitis C, HIV). However, direct or indirect blood or body fluid exposures that inoculated bloodborne pathogens into cutaneous scratches, abrasions, burns, other lesions, or on mucosal surfaces likely account for a significant proportion of occupational infections.

Dental personnel are reminded to take care of their primary defense system…their skin. A medical professional should treat skin conditions. Any cuts or lesions should be covered (e.g. plastic bandage), even though gloves are worn. Gloves and eye/face protection must be worn properly and consistently. Remember that good hand washing is the single most important procedure to prevent infection!

Hand Washing Posting Advisory

Have you received a “Hand Washing Posting Advisory” from a “Healthcare Compliance Center”?

CDC has received reports from healthcare facilities (including dental offices) in several states that the healthcare facilities have been receiving “Hand Washing Posting Advisory” advertisements from state “Healthcare Compliance Centers” concerning hand washing signage. Please be advised that this is not a CDC activity. The CDC Guideline for Hand Hygiene in Healthcare Settings and accompanying educational materials are available at the Hand hygiene home page (http://www.cdc.gov/handhygiene).

Please note that the Guideline as well as all educational materials developed by CDC are in the public domain and may be downloaded, copied (without alteration), and distributed free of charge. CDC is encouraging healthcare facilities who have additional questions about this advertisement to contact their state/local health department.

Ref. Centers for Disease Control (CDC): Hand Hygiene in Healthcare Settings

What's In Your First-Aid Kit?

Workplaces vary widely in their degree of hazard, location, size, amount of staff training and availability of professional medical service. Because of these significant variables, OSHA standards (1910.151 and 1926.50) do not require specific first aid kit contents. However, because some employers may find it useful to refer to a list of basic first aid supplies, federal OSHA provided a reference to this type of information by adding nonmandatory Appendix A to the standard. Appendix A references ANSI Z308.1-1978, “Minimum Requirements for Industrial Unit- Type First-aid Kits.” This ANSI standard was revised in 1998 and retitled: “Minimum Requirements for Workplace First Aid Kits.” First aid kits in compliance with this standard will provide a basic range of products to deal with most types of injuries encountered in the workplace.

The assortment of required items was developed based on treatment for the following potential injuries: major wounds, minor wounds (cuts and abrasions), minor burns and eye injuries. ANSI Z308.1-1998 includes the following recommended basic contents of a first aid kit.

ANSI Z308.1-1998 – Minimum requirements for workplace first aid kits: Basic kit – minimum contents
Item	Minimum Quantity
Absorbent compress, 32 sq. in. (81.3 sq. cm.) with no side smaller than 4 in. (10 cm)	1
Adhesive bandages, 1 in. x 3 in. (2.5 cm x 7.5 cm)	16
Adhesive tape, 5 yd. (457.2 cm) total	1
Antiseptic, 0.5g (0.14 fl oz.) applications	10
Burn treatment, 0.5 g (0.14 fl. oz.) applications	6
Medical exam gloves	2 pair
Sterile pads, 3 in. x 3 in. (7.5 x 7.5 cm)	4
Triangular bandage, 40 in. x 40 in. x 56 in. (101 cm x 101 cm x 142 cm)	1

Spore Testing of Sterilizers (Autoclaves)

Q. How often should dental offices test their autoclave with spore strips?

A. According the Centers for Disease Control (CDC) Guidelines for Infection Control in Dental Health-Care Settings, biological indicators (BIs) (i.e., spore tests) are the most accepted method for monitoring the sterilization process because they assess it directly by killing known highly resistant microorganisms (e.g., Geobacillus or Bacillus species), rather than merely testing the physical and chemical conditions necessary for sterilization. Because spores used in BIs are more resistant and present in greater numbers than the common microbial contaminants found on patient-care equipment, an inactivated BI indicates other potential pathogens in the load have been killed.

Correct functioning of sterilization cycles should be verified for each sterilizer by the periodic use (at least weekly) of BIs. Every load containing implantable devices should be monitored with such indicators, and the items quarantined until BI results are known.

Family Emergency Preparedness

Being prepared for an emergency, whether it be for a natural disaster, bioterriosm or infectious disease outbreak is important not only for our dental practices, but for our families. Having basic supplies available for our families is just good comment sense. A great resource is the Red Cross. See the following link on how to "Prepare for Disasters Before they Strike: Build A Disaster Supplies Kit" at: http://www.redcross.org/services/prepare/0,1082,0_91_,00.html

Breaking the Chain of Infection

A popular model used to understand the infection process is the chain of infection, a circle of links, each representing a component in the cycle. Each link must be present and in sequential order for an infection to occur. The links are: infectious agent, reservoir, portal of exit from the reservoir, mode of transmission, and portal of entry into a susceptible host.

Understanding the characteristics of each link provides the dental professional with methods to support vulnerable patients and to prevent the spread of infection. An awareness of this cycle also provides the worker with knowledge of methods of self-protection.

For example, by focusing on the transmission chain, direct or indirect contact may be interrupted by proper hand washing and strict attention to disinfection and sterilization techniques.

Ref. City Colleges of Chicago, Infection Control for Nursing Students

XDR TB: CDC Letter to Heatlhcare Providers

Dear Healthcare Professional,

A person with recently diagnosed culture-confirmed, extensively drug-resistant pulmonary tuberculosis (XDR TB) traveled on the following two extended flights (more than 8 hours in duration) in May 2007:

Date From To Airline / Flight#
May 12/13 Atlanta, Georgia Paris, France Air France #385/Delta #8517
May 24 Prague, Czech Rep. Montreal, Canada Czech Air #104

XDR TB is defined as a subtype of multidrug resistant TB (MDR TB) (i.e., an isolate resistant to at least isoniazid and rifampin), with additional resistance to at least two of the most important second-line antibiotics (i.e., a fluoroquinolone and an injectable agent [amikacin, kanamycin, or capreomycin]).

The patient is currently in respiratory isolation in a hospital in the United States, and is receiving medical therapy for XDR TB. He has remained relatively asymptomatic, and his sputum smear results were negative for acid fast bacilli (AFB), both before and after his travel; however, his sputum culture results are positive for XDR TB.

This is the first investigation of a case of XDR TB during air travel. Due to the serious nature of this strain of TB disease, CDC is recommending that all U.S. residents and citizens on these two flights receive evaluation, testing, and follow-up for TB infection.

We are requesting your assistance to perform TB evaluation and testing on any person identified as a contact on one of these flights. The XDR TB Contact Investigation Form is enclosed. Please keep a copy of this completed form for your records, give a copy to the person tested, and also please contact your State or Local TB control office via: http://www.cdc.gov/tb/pubs/tboffices.htm .

For inquiries related to this investigation, please call your State or Local Health Department. For more information about XDR TB, please see this link: http://www.cdc.gov/tb/XDRTB/default.htm.

We greatly appreciate your assistance on this important international XDR TB contact investigation.

Disposal of Dental X-Ray Fixer and Developer

Q. Is it safe to dispose dental X-Ray fixer and developer down the sink?

A. Silver-bearing wastes, including X-Ray fixer, should not be discharged to the sewer unless they are first treated in a properly sized, designed, installed, operated, maintained, and serviced standard silver recovery system. Otherwise, fixer should be taken off-site for treatment and disposal. Developer solutions should not be mixed with fixer solutions, and may only be discharged to the sewer if they have not mixed with fixer. If you are not connected to a sewer system, you should have your developer disposed of by a hazardous waste company. So, the short answer is if you are connected to a sewer, developer can be poured down the sink and if you have a silver recovery system, fixer can also be poured down a sink.

HIPAA Privacy Rules in Dentistry

Q. May a physician send out appointment-reminder postcards?

A. Yes, The HIPAA Privacy Rules allow a physician to communicate with patients, including communications to the patient's home. However, privacy and confidentiality must be maintained. For example, it is A-OK to send a postcard reminder with the date and time of the next appointment. It is not acceptable to send a postcard with specific treatment information such as "Mr. Smith, your dentures are ready".

OSHA Influenza Preparedness Guidance

As reported in the newly released, Pandemic Influenza Preparedness and Response Guidance for Healthcare Workers and Healthcare Employers, OSHA strongly urges healthcare institutions (including dental offices) to stockpile N-95 respirators and other protective equipment, warning that the items will be scarce once a pandemic strikes. "Employers and employees should not count on obtaining any additional protective equipment not already purchased and stockpiled," the report said. "Therefore, it is important for healthcare facilities to consider respiratory protection for essential personnel to assure that employees are ready, willing, and able to care for the general population."

http://www.osha.gov/Publications/OSHA_pandemic_health.pdf

Pandemic Flu Leadership Blog

On June 13, Michael O. Leavitt, Secretary, U.S. Department of Health and Human Services, is convening a leadership forum on pandemic preparedness, which brings together highly influential leaders from the business, faith, civic and health care sectors to discuss how best to help Americans become more prepared for a possible influenza pandemic. The Department is hosting this five-week blog summit to expand this conversation as part of an ongoing effort by the Department to help Americans become more prepared.

See: http://blog.pandemicflu.gov

Free Handwashing Poster

Here is a free high quality poster from the CDC for placing throughout your facility. Shows bugs that can lead to infection and may be found on unclean healthcare worker's hands.

Download English Version PDF (1 page/44KB)

Download Spanish Version PDF (1 page/158KB)

First Bird Flu Vaccine

The FDA is announced the licensure of the first vaccine in the United States for humans against the H5N1 influenza virus, commonly referred to as avian influenza or "bird flu." This inactivated influenza virus vaccine is indicated for immunization of persons 18 through 64 years of age who are at increased risk of exposure to the H5N1 influenza virus subtype contained in the vaccine. This vaccine is derived from the A/Vietnam/1203/2004 influenza virus. The vaccine is manufactured by Sanofi Pasteur Inc. of Swiftwater, PA and has been purchased by the federal government for inclusion within the Nation's National Stockpile.

Should such a bird flu pandemic emerge, the vaccine may provide early limited protection in the months before a vaccine tailored to the pandemic strain of the virus could be developed and produced. "The threat of an influenza pandemic is, at present, one of the most significant public health issues our nation and world faces," said Andrew C. von Eschenbach, M.D., Commissioner of Food and Drugs. "The approval of this vaccine is an important step forward in our protection against a pandemic."

Should a Dental Office Stockpile Antivirals?

According to a report published by the Center for Infectious Disease Research & Policy (CIDRAP), “At least 5 to 6 months into a pandemic, until a vaccine can be made and distributed, antiviral drugs for influenza (ie, antivirals) will be the only pharmacologic option for potentially preventing, shortening, or reducing the severity of illness among employees. Given grim estimates of 30% absentee rates, offering employees antivirals as part of a prevention or treatment strategy could appear to be a cost-effective way of both reducing worker absenteeism and bolstering employees' confidence in their company.

In a recent poll of 120 preparedness professionals attending the CIDRAP summit on business preparedness for pandemic influenza in February, 37% of the participants (many from Fortune 500 companies), said their firms had purchased or were planning to purchase antivirals for distribution to employees during a pandemic.” (May 11, 2007: CIDRAP News: http://www.cidrap.umn.edu/cidrap/content/influenza/biz-plan/news/051107antivirals.html)

Should dental offices consider stockpiling and potentially distribute antivirals (e.g. Tamiflu) to their employees? Although it is a difficult decision based on issues such as supply, distribution and timing, Dynamic Dental Safety recommends that dental offices should at least explore this option as part of a comprehensive emergency preparedness plan.

Lead Aprons in Dentistry

On the right is a depiction of a lead apron and thyroid collar that is typically used in the dental office. This is directed to be worn by the patient in the act of taking dental x-rays.

Many dental offices are now converting to and installing digital radiographic equipment. The amount of radiation delivered to the patient during this digital type of exposure is significantly less than the traditional x-ray equipment.

Taking this into account, we often get asked the question regarding the necessity for the patient to wear this protective lead apron with the usage of digital x-rays. The answer that we give is that the dental office should always consider the "worst possible scenario" in that if something were to happen to the patient at that moment or in the future......... the rememberance of not having the protective apron will be etched in the mind of the patient. The patient then might decide to take things to the next level.

The advice that we at Dynamic Dental Safety give to all of our clients is to practice "risk prevention", and in this case to always have the patient wear the lead apron during times of x-ray exposure.

For this or any other compliance issue or question, call us at Dynamic Dental Safety (888) 669-8846 ext. 701

Don't Block Your Fire Sprinklers!

Fire sprinklers are an essential and effective means of fire protec­tion for people and buildings. Often, how­ever, dental supplies and other stacked items are placed near or around sprinkler heads, blocking the range of the sprinkler and greatly reducing its effectiveness. Nothing should ever be placed any higher than 18 inches below a sprinkler or positioned in such a way as to block a sprinkler’s full range of coverage.

Hige storage of items can also create unstable loads and create a fall hazard. Pay attention to the organization of your storage closets. Minimize the storage of non-essential items and keep the area tidy.

Dental sharps container safety

Let's look at the opening at the top of the typical sharps container found in the dental office. We notice that there are multiple holes on the circumference. Most of the dental office does not even take note of these, however they are an important part of the safety solutions for the dental office.

The four holes that are similar are for the securing of the cover for the sharps container when it is deemed to be full. This is in most cases when the container is 2/3 to 3/4 full so as not to make it difficult to place something in the sharps container without undue force.

The two holes that we see on the extreme right and left of the picture are for the purpose of safely removing the needle from the syringe. This is done by inserting the needle into the opening and sliding it so as to engage the ribs on the hub of the needle. Next the needle can be disengaged by rotating the hub of the syringe and the needle will fall directly into the sharps container.

This method can be used with or without the needle being capped. We have demonstrated that the dental office has implemented "safer medical/dental devices" with the proper usage of pre-existing materials.

For compliance advice for the dental office please contact Dynamic Dental Safety at (888) 669-8846 ext. 701

Electrical Surge Protector/Power Strip Safety

Do NOT plug a surge protector or power strip into an existing surge protector or power strip. This practice is called "daisy-chaining" or "piggy-backing" and can create a serious hazard. There should only be one surge protector or power strip plugged into a single duplex electrical outlet.

- Power strips should not be overloaded. Most are rated for 15A. This equates to approximately 1500 watts of power connected to the device.

- Surge protectors, power strips, and/or extension cords are NOT a substitute for permanent wiring.

- Do NOT locate a surge protector or power strip in any area where the unit would be covered with carpet, furniture, or any other item that will limit or prevent air circulation.

- Do NOT staple, tack, or tape a surge protector or power strip.

Gas Cylinder Safety in Dental Offices

Safety is all important in the dental office. To this end it is essential that each and every employee in the dental office participate ... by observing and either correcting the issue or bringing it to the attention of an individual who has the ability to correct the offending issue.

Additionally, certain items should be checked on a regular basis. This is necessary in the documentation to "prove" that we not only say that we check items, but that in truth we do .. and place this in writing. Creating this "performance based" program in the dental office is one of the items that Dynamic Dental Safety helps to "walk the staff through" in providing our OSHA/Risk Prevention services.

One of the items to check on a regular basis are the compressed gas cylinders. These should be checked in the following way:

Compressed Gas Tanks should be visually checked to ensure:

The area of storage is clearly marked
The tanks are secured
There is no obstruction present
The regulators for the tanks are in place and functional

For further information regarding this or any compliance issue in the dental office, please contact Dynamic Dental Safety at (888) 669-8846 ext. 701

Hepatitis B Declination Statement

The following statement of declination of hepatitis B vaccination must be signed by an employee who chooses not to accept the vaccine. The statement can only be signed by the employee following appropriate training regarding hepatitis B, hepatitis B vaccination, the efficacy, safety, method of administration, and benefits of vaccination, and that the vaccine and vaccination are provided free of charge to the employee. The statement is not a waiver; employees can request and receive the hepatitis B vaccination at a later date if they remain occupationally at risk for hepatitis B.

Declination Statement: I understand that due to my occupational exposure to blood or other potentially infectious materials I may be at risk of acquiring hepatitis B virus (HBV) infection. I have been given the opportunity to be vaccinated with hepatitis B vaccine, at no charge to me; however, I decline hepatitis B vaccination at this time. I understand that by declining this vaccine I continue to be at risk of acquiring hepatitis B, a serious disease. If, in the future I continue to have occupational exposure to blood or other potentially infectious materials and I want to be vaccinated with hepatitis B vaccine, I can receive the vaccination series at no charge to me.

Employee Signature:_____________________________ Date:____________________

Adapted from OSHA etools

Safer Medical Device Implementation in Dental Offices

Since the passage of the Needlestick Safety and Prevention Act in 2000 and the subsequent revision of the OSHA Bloodbornes Pathogen Standard, all health care facilities, including dental offices are required to use safer medical devices. To assist facilities that are working through this process, The National Institute for Occupational Safety and Health (NIOSH) has asked a small number of facilities to share their experiences on how they implemented safer medical devices in their settings. These facilities have agreed to describe how each step was accomplished, and also to discuss the barriers they encountered and how they were resolved, and most importantly, lessons learned.

Click on the following link and scroll down to “Dental Facilities Results” to learn about the experiences of two different dental facilities: http://www.cdc.gov/niosh/topics/bbp/safer/Step1b.html

Alcohol-Based Hand Rinses in Dental Offices

Q. Is it acceptable to use alcohol-based hand rinses in dental offices?

A. Yes, in fact, using waterless alcohol-based agents is now considered by the CDC to be the preferred method of skin asepsis. Most formulations contain emollients to soften skin and prevent dryness. Other benefits include rapid and effective antimicrobial action and increased hand asepsis compliance, as these products provide enhanced accessibility and convenience.

However, there are several limitations such as they can not be used if hands are visibly soiled and they should be stored away from high temperatures or flames. In addition, since hand softeners and glove powders may “build-up” on one’s hands, handwashing with soap and water may be needed after every 3-5 applications.

Work-Related Injuries

"Data collected through a National Electronic Injury Surveillance System occupational supplement (NEISS-Work) provide information on persons treated for nonfatal work-related injuries and illnesses in U.S. hospital emergency departments (EDs). CDC's National Institute for Occupational Safety and Health uses these data to monitor injury trends and aid prevention activities. This report summarizes 2004 NEISS-Work injury and illness surveillance data. In 2004, an estimated 3.4 million nonfatal ED-treated injuries and illnesses occurred among workers of all ages, with a rate of 2.5 cases per 100 full-time equivalent (FTE) workers aged >15 years.

More than three fourths of all nonfatal workplace injuries/illnesses were attributed to contact with objects or equipment (e.g., being struck by a falling tool or caught in machinery), bodily reaction or exertion (e.g., a sprain or strain), and falls. No substantial reduction was observed in the overall number and rate of ED-treated occupational injuries/illnesses during 1996—2004."

Ref. MMWR: April 27, 2007 / 56(16);393-397 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5616a3.htm?s_cid=mm5616a3_e%0A

Comment: Injuries (e.g. sharps injuries, work related musculoskeletal disorders, etc.) in dental personnel continue to occur at unacceptable rates. Your employees are your most valuable asset. Please contact Dynamic Dental Safety (888-669-8846, ext. 701) for information on our on-site training programs designed to help prevent dental work-related injuries and illnesses.

Safety issue........ hazardous materials

Note the picture at the left taken in a dental office a short while ago. There are multiple issues that can be seen as safety/OSHA or risk to dental professionals in the office.

The first of the issues that is noted is that the label on the container is not appropriate. Either a manufacturer's original label or an appropriate secondary container label (Dynamic Dental Safety can provide a customized specific label) should be evident on the container.

Next, and a slight bit less obvious is the fact that this bottle is resting on the floor. Should this item tip over, spill or leak in any way - the contamination of the underlying floor surface and cleanup would be extensive. A simple solution to this would be to place the container in a "boot tray" or other containment item. This would simplify the process of cleaning, thus saving time and expense for the dental office.

For solutions to this or other safety and risk areas relating to compliance in the dental office, please call Dynamic Dental Safety at (888) 669-8846 ext. 701

It's Not Too Late!!!!!!!!....the NPI time is here for dentists

The time is coming close for the implementation of the third part of the HIPAA regulation applicable to dental offices. The American Dental Association states the following:

Any health care provider who uses standard electronic transactions, like electronic claims, eligibility verifications, claims status inquiries, and claim attachments, will be required by federal law to start including NPIs on electronic transactions not later than May 23, 2007. In addition, those dentists who use only paper, voice and fax to transmit these communications may find NPIs useful or necessary for other reasons. Many dental plans will require dentists to include NPIs on paper claim submissions, so even paper based dentists may find it a necessity to have NPIs.

Thus, our recommendation is to apply for and implement this as soon as possible. Following this link to the ADA article will allow each and every dental professional and dental office to make application either online or via mail:

http://www.ada.org/prof/resources/topics/npi.asp

For assistance with this or any other compliance issue for the dental office, please contact us at Dynamic Dental Safety at (888) 669-8846 ext. 701

Show Your Infection Control Practices to Your Patients

The general public is becoming increasingly aware of infection control and other safety practices in healthcare. Newspapers, television and radio news carry daily stories on emerging pathogens, antibiotic resistant bacteria, foodborne poisoning, avian influenza, medical errors, etc. Your patients expect that your office is following "state-of-the-art" safety practices and are watching that you implement them consistently.

For example, we have heard about dental offices where a patient calls OSHA with a complaint that they observed their dentist not changing gloves and/or washing their hands before starting their procedure. When we investigate these complaints, we usually find that the dentist changed gloves and washed their hands in another operatory or sink area (i.e. not viewed by the patient). We recommend that you try to change gloves and wash your hands in front of your patient. By demonstrating good infection control practice, your patients will acknowledge that you consider their safety as number one!

How Do You Clean Utility Gloves?

Since utility gloves (i.e. heavy rubber gloves used when handling chemicals) are reusable, they may be decontaminated with 1:10 bleach or an EPA approved disinfectant. However, utility gloves should be inspected before and after use and discarded if they are cracked, peeling, torn, punctured, or exhibit other signs of deterioration or when their ability to function as a barrier is compromised.

Safe Usage of Dental Products

Just by viewing the container of Clorox wipes to the left in the dental office does not tell us the whole story. Exactly what do we mean by this?... well we must look for certain statements either on the container label or on the MSDS sheet if we have that available in the dental office.

First, in order to utilize an item for disinfection of countertops in the dental office (or cleaning any surface in the dental office that may be contaminated with bodily fluids) - that product must have the classification of being "tuberculocidal". In simple terms, it has been tested and is at the level required to disinfect the dental countertop and other non-porous materials at the appropriate level.

Additionally, we should be aware of the proper methods of addressing any injury from the chemicals within the product. One of the important items that we should be aware of and train our staff on is the use of the eyewash. An often overlooked item is placed right on the label of most products and that is the time of use to rinse our eyes if we are exposed to the chemical in the dental office.

As we can see the time listed on the right... the back of the label of the product.. tells us that we should rinse our eyes for 15-20 minutes. The importance of training our staff and additionally any "temporary" employees in both this as well as the location of the eyewash is essential in our dental office.

For help or clarification with this or any other dental compliance questions please contact us at Dynamic Dental Safety at (888) 669-8846 ext. 701