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.