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Changes can be made beyond disinfectant products and procedures - consider team morale and protocol adherence.
We tend to think only of the dental clinic as the only place where infection prevention breaches can occur, but bad things can transpire in the dental laboratory as well. Certainly, lab techs don’t come in contact with patients - except for those rare instances where he or she works for a dentist and is called in to consult on a case - but that doesn’t alter the fact that care needs to be taken in the lab to ensure staff safety.
Personal protective equipment
The chief source of infection prevention is the same at both the laboratory and the clinic, and it should be a surprise to no one.
“Probably the biggest infection prevention issue is the proper use of personal protective equipment (PPE),” says lab safety consultant Daniel J. Scungio, MT (ASCP), SLS, CQA (ASQ). “[PPE is] certainly mandated by OSHA - what kinds … and when they’re being used. And that applies even when the patient’s in the dental office, as well. It’s definitely an issue for infection prevention - it’s a good way to get something and bring it home, if you’re not wearing your gloves, wearing a lab coat or wearing your face protection.”
It seems like an obvious, simple means to avoid problems. So why aren’t people using their PPE?
“There are a lot of reasons for noncompliance,” Scungio says. “It could be the culture of the workplace, it could be training or it could be a lack of convenience. It’s hard to get people to do the right thing with PPE - or anything - if it’s hard. You have to make it easy for them to do it. A good example for that would be, ‘I want you to wear a lab coat, I want you to wear gloves, and I want you to wear goggles, but I’m going to put the lab coats in a store room down the hall, and there’s a keypad code to get in.’ Are people going to do that? Are people going to remember the keypad code? I’ve actually seen this situation before. You have to make it easy for people to do the right thing, and that means you have to provide the PPE; you have to make it easy for them to wear it; and if you want them to remove it before they leave the lab, which is required by OSHA, then put a hook at the door on or something to hang it before they leave so that they’re doing the right thing.”
Workers may eschew PPE simply because they’re never called on it.
“Some people just don’t comply because there’s no enforcement in the lab areas for the use of PPE, and it’s a hot day, and, ‘Oh, it’s too hot to wear lab coat,’” Scungio says. “Which is never a reason not to wear PPE. You adjust the environment or you offer lightweight lab coats… and you provide what’s necessary for your staff in the right way, and then you make sure enforcement occurs.
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Disinfection and sterilization
Dental labs don’t have a direct contact with patients, but infection transmission is still possible.
“I’ve visited labs that routinely receive items that either were not cleaned and disinfected or their status was suspect,” says Karen Daw of Karen Daw Consulting. “Cross-contamination can occur when ‘dirty’ impressions, dentures and prosthetics are sent to the lab, or by improper handling and protection once these items are received in the laboratory. Studies have shown harmful microorganisms present, including bacteria such as E. coli. Gram-negative bacilli have been found in pumice, and, in one study, employees exposed to lathe aerosols had developed a respiratory illness. In fact, tuberculosis was able to be cultured from partials of known TB patients. I even once saw bags of alginate impressions containing mold.”
We want to assume that everyone is doing their job with infection prevention mind; however, that can be a mistake.
“When discussing proper cleaning, disinfection and sterilization within the dental office, the dental lab is an area that seems to be overlooked,” Daw says. “Offices are instructed to confirm chemical indicator change on pouches when removing, storing, and before opening instruments; however, it can be next to impossible to look at the bag received in the lab and confidently state, ‘Yes, this has obviously been disinfected” because there are no convenient chemical indicators to indicate proper disinfection. For that reason, the lab should not assume the item in a sealed bag was disinfected properly, or disinfected at all, for that matter. It would be helpful if bags arrive with a label that state items were disinfected, with what product, for how long and by whom. Labs could include… a disinfection step once the items arrive.”
Even though labs don’t have direct contact with patients, they can still come in contact with infectious diseases. As such, lab workers should have the same protections as other healthcare workers - including trainings and access to inoculations.
“Because there is the likelihood of exposure to bloodborne pathogens, the employer must offer the Hepatitis B vaccination to employees, and lab personnel should be included in regular infection control and OSHA BBP training,” Daw says. “Other infection control considerations include changing the pumice slurry and sterilizing polishing wheels between use. Lathes, pumice, and equipment used to polish or finish prosthetics can be a source of contamination. Finally, PPE should be used, and includes the use of gloves, masks, safety eyewear and gowns. Training on the proper way to don, use and remove PPE, as well as limitations of the PPE must be discussed with the lab team.”
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Attentiveness and preventative accidents
In addition to lab-related mishaps, simple carelessness is another source of preventable risk.
“Often, personal injury comes from not paying attention to your surroundings or the work you’re doing,” Scungio observes. “You could have a slip, trip or fall.”
“It’s things like ergonomics injuries, or a staff member may open a cabinet and then stand up and forget it was open, they hit their head - that definitely is common,” he says. “You have to teach people to pay attention to their surroundings at all times. You could slip on something - maybe someone spilled some liquid on the floor and nobody cleaned it up or noticed it. Those kinds of injuries are quite common…Teaching people to be alert and paying attention is part of raising overall safety awareness.”
Making workers aware of these hazards comes down to reminders, education, and training.
“Definitely ongoing education with an annual training or safety stand-downs,” Scungio says. “If there is an issue, you should hold a safety stand-down, and that means everybody stops what they’re doing until you go over this particular issue with them, one-on-one or in small groups, and cover it. If you don’t hold a safety stand-down for a big issue that’s recurring, you will continue to have those issues.”
Those stand-downs may be part of routine training or it might necessitate everyone stopping their work for a while.
“If we do staff huddles every day, make sure there is time for safety during those huddles and share a safety story,” Scungio says. “Even if you’re telling internal stories, it raises awareness of potential issues in your department and people are more likely to pay attention.”
Getting workers and staff to fall in line and follow safety rules is a matter of both figuring out their motivation and being a little heavy-handed.
“Part of noncompliance is not understanding the consequences,” Scungio says. “One of the things you have to do is tell safety stories. They’re not always stories with happy endings, but you have to talk to people about the consequences of unsafe situations.
The safety story need not only be specific to a particular workplace, but can be used to underscore the necessity for safety.
“A couple of summers ago, the CDC investigated an outbreak of Salmonella infections across the country,” Scungio illustrates. “And when they interviewed the people that got sick, the people were saying. ‘I didn’t wear my PPE and I brought my pen home that I use the lab,’ or ‘I was using my cell phone in the laboratory space.’ Well, guess what? You brought a bug home and it got you sick, and it could’ve killed you, if it was bad enough. They were lucky. It didn’t happen this case, but it was such an outbreak across the country, that it’s important to tell those stories.”
For others, money talks, and it could impact both the lab and the worker.
“Other people respond if you talk to them about financial consequences,” Scungio says. “Tell them how much an OSHA fine is. ‘This is how much the organization could be fined, and it’s a lot of money.’ Some people just respond out of fear. You have to know your employees and, in the world of safety, you have to use all those things to motivate your staff. Education and raising safety awareness is definitely the key to get good compliance.”
Workplace safety is not glamorous and … it may be seen as a second thought. However, it is vitally important in any workplace, including dental labs.
“Oftentimes, the safety department or people who work with safety don’t really get a budget,” Scungio observes. “So, you kind of have to operate the safety program on nothing, but it’s possible to do it. Some of the things that are part of the safety program do cost money, like PPE and things like that, and engineering controls, but you have to remember my tagline, ‘safety is always value added.’ It’s always worth the money to put something in place for safety, and that’s an important message for… people in leadership.”