Avoiding occupational exposures to blood is the primary way to prevent transmission of HBV, HCV and HIV to HCP in healthcare settings. Exposures occur through:
• Percutaneous injury (eg, a needlestick or cut with a sharp object)
• Contact between potentially infectious blood, tissues or other body fluids and mucous membranes or non intact skin (eg, exposed skin that is chapped, abraded or shows signs of dermatitis).
Observational studies and surveys show that there are less percutaneous injuries now occurring among DHCP. This may be attributed to safer work practices, as well as instrument engineering and design and continuous information.
Percutaneous injuries among DHCP usually are caused by burs, syringe needles, laboratory knives and other sharp instruments. Injuries among oral surgeons might occur more frequently during fracture reductions using wires.
While many of these exposures are rare, needlesticks and other blood contacts continue to occur, which is a concern because percutaneous injuries pose the greatest risk of transmission. Standard precautions include use of Personal Protective Equipment (PPE) intended to prevent skin and mucous membrane exposures (eg, gloves, masks, protective eyewear or face shield and gowns). Other protective equipment (eg, finger guards while suturing) might also reduce injuries during dental procedures.
Methods to reduce exposures to blood and OPIM from sharp instruments and needles may be technology-based and often incorporate safer designs of instruments and devices (eg, self-sheathing anesthetic needles and dental units designed to shield burs in handpieces) to reduce percutaneous injuries.
Work-practice controls establish practices to protect DHCP whose responsibilities include handling, using, assembling or processing sharp devices (eg, needles, scalers, laboratory utility knives, burs, explorers and endodontic files) or sharps disposal containers. Work-practice controls can include removing burs before disassembling the handpiece from the dental unit, restricting use of fingers in tissue retraction or palpation during suturing and administration of anesthesia, and minimizing potentially uncontrolled movements of such instruments as scalers or laboratory knives.
1. General recommendations:
a. Use standard precautions (OSHA’s blood-borne pathogen standard retains the term universal precautions) for all patient encounters
b. Consider sharp items (eg, needles, scalers, burs, lab knives and wires) that are contaminated with patient blood and saliva as potentially infective and establish engineering controls and work practices to prevent injuries.
c. Implement a written, comprehensive program designed to minimize and manage DHCP exposures to blood and body fluids
2. Engineering and work-practice controls:
a. Identify, evaluate and select devices with engineered safety features at least annually and as they become available on the market (eg, safer anesthetic syringes, blunt suture needle, retractable scalpel or needleless IV systems)
b. Avoid handling sharps directly with bare hands
c. Place used disposable syringes and needles, scalpel blades and other sharp items in appropriate puncture-resistant containers located as close as feasible to the area in which the items are used
d. Do not recap used needles by using both hands or any other technique that involves directing the point of a needle toward any part of the body. Do not bend, break or remove needles before disposal
e. Never pass an unsheathed needle
f. Use either a one-handed scoop technique or a mechanical device designed for holding the needle cap when recapping needles (eg, between multiple injections and before removing from a nondisposable aspirating syringe)