Chapter 19: Sharps Safety

Copyright © 2017, Elsevier Inc. All Rights Reserved.
Sharps Safety
Chapter 19
1

Learning Objectives
Lesson 19.1: Preventing Sharps Injuries
1. Describe some of the risks from sharps
injuries.
2. List some examples of when sharps injuries
may occur in a dental office.
3. Describe a safety culture and list the three
basic approaches to preventing sharps
injuries.
2

Risks from Sharps Injuries
 Sharps is a term for devices with sharp points
or edges that can puncture or cut skin or
other tissue
 The chances of acquiring an infectious disease are
low but do exist.
 The United States Public Health Service (USPHS)
has indicated that in health care personnel who have
sustained injuries from needles contaminated with
blood containing hepatitis B virus (HBV), the risk of
developing clinical hepatitis was 22% to 31% if the
blood was both HBsAg-positive and HBe-Ag positive.
3

Examples of Sharps
4

 Figure 19.1 shows examples of sharps
(scalpel, anesthetic needle, suture needle,
wire, file, band, broken instrument, bur,
anesthetic carpule [if broken]).
 What are some examples of dental sharps?
 Examples include injection needles, orthodontic
bands and wire, scalpel blades, burs, suture
needles, instruments, and broken glass.
5

When Can Injuries Occur?
 Sharps injuries can occur anytime when
handling a sharp item
 See Box 19.1 for list of examples when
sharps injuries can occur at chairside, during
instrument processing, and other
miscellaneous times.
 If the sharp has been used on a patient or
has otherwise contacted a patient’s blood or
saliva, it is contaminated and has a potential
to transmit microbes.
6

Simulated Instrument Puncture
7
Figure 19.2 shows a simulated instrument puncture.
Everyone is concerned about any type of injury that
occurs in the office, but contaminated injuries offer the
added grief of a potentially harmful infection.

Safety Culture
 A safety culture reflects the shared
commitment of the employer and employees
toward ensuring the safety of the work
environment
 Employers should openly support a safety
culture by:
 Providing adequate supply of resources
 Engaging worker participation in safety planning
 Making available appropriate safety devices and
protective equipment
 Introducing workers to a safety culture when they
are first hired
8

 A “culture of safety” is the overall strategy the CDC
recommends to adopt in the office.
 Other components of a safety culture include:
 Identifying and removing sharps injury hazards
 Developing feedback systems to communicate safety (e.g.,
newsletters, bulletin boards, brochures, meeting agendas,
rewards for identifying dangerous situations, celebrations
for success and improvements)
 Promoting individual accountability (e.g., assess safety
compliance, have staff sign a pledge to promote safety)
 Measuring improvements in safety (e.g., before and after
survey of staff perception of safety in the office, sharps
injury reports)
9

OSHA’s Needlestick Prevention Act
 In 2001, OSHA revised the bloodborne
pathogens standard to include requirements
of the Needlestick Safety and Prevention Act
 Revisions modified the definitions section of
the standard; made additions to the exposure
control plan; required the employer to solicit
input from employees in the identification,
evaluation, and selection of engineering
controls and work practices that prevent
exposure; and required the maintenance of a
sharps injury log for some employers.
10

Exposure Control Plan
 Exposure control plans should be revisited on
an annual basis for revisions
 Why are exposure control plans required to
be re-visited annually?
 “To [a] reflect changes in technology that eliminate
or reduce exposure to bloodborne pathogens; and
[b] document annually consideration and
implementation of appropriate commercially
available and effective safer medical devices
designed to eliminate or minimize occupational
exposure”
11

Exposure Control Plan
 The changes further require that “an employer, who
is required to establish an exposure control plan,
shall solicit input from non-managerial employees
responsible for direct patient care who are
potentially exposed to injuries from contaminated
sharps in the identification, evaluation, and selection
of effective engineering and work practice controls
and shall document such solicitation in the exposure
control plan.”
 All employers still have to report any workplace
incident that results in a fatality or the hospitalization
of three or more employees. 12

Specific Prevention Approaches
 There are three basic approaches to preventing
sharps injuries
 Eliminate the use of the sharp when possible
 Apply engineering controls
 Apply work practice controls
 What are engineering controls?
 Devices that remove the potential hazard; for example,
engineered medical devices with sharps injury prevention
features such as a protective needle sheath–sharps
containers
 What are work practice controls?
 Actions that alter the manner in which a task is performed,
such as the one-handed scoop technique for recapping a
used needle
13

Proper Handling
 Proper handling of sharps is essential
because common personal protective barriers
such as exam gloves often do not prevent
sharps punctures or cuts
 To minimize the potential for accidents with
injection needles, use some type of protective
cap-holding device or replace the cap sheath
using the one-handed scoop technique.
 Box 19.2 gives some examples of sharps
safety.
14

One-Handed Scoop Technique
15

Parenteral Medications
 These are all examples of safe injection
techniques for parenteral medications.
 Use single-dose vials for parenteral medications
whenever possible
 Don’t use needles/syringes for more than one patient
 Medication containers are entered with a new needle
and syringe
 Don’t use single-dose medication vials, ampules, bags,
or bottles of intravenous solution for more than one
patient
16

Parenteral Medications (Cont.)
 Don’t combine the leftover contents of single-
use vials for later use
 Don’t use fluid infusion or administration sets
 For dental anesthetic injections, the CDC
recommends to not use the needle or
anesthetic cartridge for more than one
patient.
17

Chapter 19: Sharps Safety

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