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Robert Elsenpeter is a freelance writer and frequent contributor to Dental Products Report and Digital Esthetics. He is also the author of 18 technology books, including the award-winning Green IT: Reduce Your Information System's Environmental Impact While Adding to the Bottom Line. As such, he’s particularly interested in the technological side of dentistry.
Sharps injuries can be stressful and costly, but a little due diligence and teamwork can go a long way toward creating a safe environment.
Infection transmission at the dental practice can occur through any number of methods, but perhaps the most frightening is via a sharps injury. According to the Centers for Disease Control and Prevention (CDC), about 385,000 sharps-related injuries occur annually among workers in hospital settings.
Those injuries aren’t just limited to those directly working with patients. Whoever might come in contact with the potentially contaminated sharp instrument is at risk.
“Most reported needlestick injuries involve nursing staff, but laboratory staff, physicians, housekeepers and other healthcare workers are also injured,” states The National Institute for Occupational Safety and Health (NIOSH). “Some of these injuries expose workers to bloodborne pathogens that can cause infection. The most important of these pathogens are HBV, HCV and HIV. Infections with each of these pathogens are potentially life-threatening – and preventable.”
There are, of course, costs associated with sharps injuries - both tangible and intangible. According to the CDC, costs can range from $71 to almost $5,000, depending on the treatment provided. Costs that are harder to quantify include the emotional cost associated with fear and anxiety from worrying about the possible consequences of an exposure, direct and indirect costs associated with drug toxicities and lost time from work.
Preventing needlesticks and other sharps injuries is avoidable, but, like so many other infection prevention efforts at the practice, it requires education, effort and diligence.
Safer medical devices
Environmentally speaking, practices should evaluate how and where sharps are handled and managed.
“Place sharps containers in the treatment rooms rather than in a central area, such as sterilization, to avoid transporting them and handling them any more than necessary,” says Mary Borg-Bartlett, president of SafeLink Consulting. “The CDC considers this the best practice for avoiding sharps injuries. The placement of the sharps container at point of use is essential. Avoid having to open a cabinet door or reach around equipment in order to dispose of the sharp items.”â¨In an effort to reduce needlesticks, OSHA further directs practices in workplace safety.
“As all employers should know, the Occupational Safety and Health Administration requires annual training in bloodborne pathogens (BBP),” says Karen Daw, a speaker and consultant. “Yet few are familiar with the Needlestick Safety and Prevention Act modifying OSHA’s BBP standard with a requirement for employers to ‘identify, evaluate and implement safer medical devices.’ Currently, OSHA’s BBP standard requires the use of engineering controls in the practice to prevent exposures from occurring. What the new act did was define engineering controls to include safer devices. Even if the practice has never experienced a needlestick, the standard was implemented to prevent injuries from contaminated sharps. The annual evaluation must include representatives from nonmanagerial positions and is documented as part of the practice’s exposure control plan.”
Even though the Needlestick Safety and Prevention Act dates back to 2000, many practices may simply be unaware of it.
“I think the largest obstacle I’ve seen in implementing safer needle devices is that offices are not aware they must evaluate or are unaware of where to find devices to evaluate,” Daw continues. “If the practice needs assistance with this, a consultant will be able to walk the team through the process, educate on where to find devices and the forms used for evaluation, and answer questions about implementation.”
The less contact employees have with sharps, the better. Mechanical methods are best to avoid physical, human contact.
“Use engineering controls to recap needles,” Borg-Bartlett says. “There are a number of devices available that are designed for this purpose. If the needle is to be recapped manually, then work practice controls such as the one-handed scoop technique should be used. Other work practice controls recommended by the CDC can include not bending or breaking needles, not passing a syringe with an unsheathed needle by hand, using instruments and not fingers for tissue retraction or palpation during suturing, and administration of anesthesia.”
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The best place to start a sharps injury prevention initiative is by ensuring that everyone in the practice is adequately educated.
“Just as my realtor once told me, it’s all about ‘location, location, location,’” Daw says. “I tell my practices that preventing sharps injuries comes down to ‘education, education, education.’ If the team doesn’t receive the proper information on how sharps injuries occur and how to prevent them, we can almost guarantee one.”
Understanding what instruction has already be provided, and then where incidents have resulted, reveals any training gap.
“When I do a consult, I always ask for the training records and sharps injuries log,” Daw says. “One tells me what information the team has received in the area of sharps injuries prevention, and the other gives me a better understanding of the types of sharps injuries and if there’s a pattern. This also tells me how deep of a dive I’ll need to take during our training session on the subject.”
The CDC offers a resource to help practices develop their own sharps injury prevention program in its “Workbook for Designing, Implementing and Evaluating a Sharps Injury Prevention Program.” The workbook can be found online at https://www.cdc.gov/sharpssafety/pdf/sharpsworkbook_2008.pdf.
Maybe the most important component in preventing sharps-related injuries is by embracing a culture of safety. This involves factors that influence overall attitudes and behaviors. A safety culture starts at the top with the leadership’s example, which is then passed on to the employees.
According to the CDC, that safety culture is based on several factors, including:
Safety culture shouldn’t be confused with environmental safety, however. Environmental safety is the physical, hands-on measures taken to ensure safety. Safety culture, on the other hand, is an overall attitude toward embracing safety.
There is, of course, a value to engendering a safety culture.
According to the CDC, “Some industrial sectors have found that having a strong safety culture is positively associated with productivity, cost, product quality and employee satisfaction. Organizations with strong safety cultures consistently report fewer injuries than organizations with weak safety cultures, not only because the workplace has well-developed and effective safety programs, but also because management, through these programs, sends ‘cues’ to employees about the organization’s commitment to safety.
While the idea of systematically adopting a safety culture is relatively new for the health care industry, there are some published studies of its effects in some health care organizations. Safety culture has been linked with both employee compliance with safe work practices and reduced exposure to blood and other body fluids, including reductions in sharps-related injuries.”
Creating or enhancing the practice’s safety culture involves influencing employee attitudes and behaviors, along with reducing environmental hazards. The CDC recommends:
Sharps injuries can be traumatic, stressful and costly. But, like so many other infection prevention efforts, approaching the issue with thoughtfulness, diligence and teamwork can help to prevent such incidents.