1. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 1 Chapter 10 Management of Hazardous Material

2. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 2 OSHA’s Objective To provide a safe work environment for all employees

3. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 3 Bloodborne/Hazardous Materials Standard Methods of compliance –Standard precautions –Engineering and work practice controls –PPE –Housekeeping

4. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 4 Standard Precautions All human blood and OPIM are considered infectious. The same precautions must be taken with all of the following: –Blood –Saliva –Tissue

5. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 5 Universal Precautions Treat and prepare as if each patient has a potentially infectious disease –Hepatitis B virus (HBV) –Hepatitis C virus (HCV) –Human immunodeficiency virus (HIV) Achieved through engineering and work practice control standards

6. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 6 Employee “right to know” law –Employees have the right and need to know the identity and health hazards of the chemicals they use in a dental office. Hazard Communication Standard

7. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 7 Hazard Communication Program Employee training Chemical inventory record Safety measures for handling of chemicals Product MSDS sheets Labeling of chemical containers

8. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 8 Employee Training Required for all employees with occupational exposure –On hire –Annually –On introduction of new procedure or product Must be interactive –Followed by question and answer session

9. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 9 Training Records Date of training Summary of training Name and qualifications of trainer Name and job title of attendees

10. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 10 Hepatitis B Vaccine Recommended for all healthcare providers Provided within 10 days of hire Provided at no cost to employee If employee refuses, then waiver must be signed –Made available if employee changes mind

11. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 11 Administering Vaccination Administered in a series of three injections Scheduled at 0,1, and 6 months Injection given in arm (deltoid muscle) Commonly used vaccines –Recombivax HB –Engerix-B

12. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 12 Components of Exposure Control Plan A written plan for occupational exposure Written policies and procedures for complying with the standard Reference guide for policies and procedures

13. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 13 Employees list tasks and identify category of risk Laboratory technician Assistant Hygienist Dentist Exposure to blood, saliva, and body tissue Category One Receptionist Coordinating assistant Occasional exposure Category Two Insurance processor Accountants No exposure Category Three Exposure Control Plan Job Classifications Occuptaional Exposure Determination

14. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 14 Occupational Exposure Contact with blood or OPIM through any of the following: –Eyes –Skin –Mucous membranes –Parenteral piercing of membranes by any of the following: Needle stick Cuts Abrasions

15. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 15 Occupational Exposure Incident Employee exposed to infectious material –Report it immediately –Receive medical evaluation and follow-up examination –Identify the route of exposure –Identify the source patient –Request that source patient be tested –Employee has the right to refuse testing

16. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 16 Post-Exposure Plan Counseling Prophylaxis treatment –Injections of gamma-globulin –Tetanus –HBV vaccine booster –Education of preventing sexual transmission Employer not responsible for costs associated with treatment of disease

17. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 17 Records kept throughout employment plus 30 years Remain confidential Records include the following: –Vaccination status –Post-exposure follow-up evaluation –Healthcare professional’s written opinions Employee Medical Records

18. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 18 Material Safety Data Sheets Identifies chemicals in product States health and safety information Provided by manufacturer One copy for each dental product Stored in notebook with easy reference guide

19. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 19 Chemical Warning Labels Developed by the National Fire Protection Agency Warns employees using chemicals about hazards

20. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 20 Methods of Minimizing Aerosols Place lids on ultrasonic cleaner Do not spray chemicals –Saturate paper towels, then wipe Use HVE suction Apply rubber dam Wear masks and protective eyewear

21. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 21 Ways in which Chemicals Enter the Body Inhalation Ingestion Skin

22. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 22 Engineering/Work Practice Controls The physical equipment and mechanical devices employers provide to safeguard and protect employees

23. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 23 Examples of Engineering Controls Splash guards on model trimmers Sharps containers near place of use Ventilation hood Eye wash station Sterilizers and ultrasonic cleaners

24. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 24 Eye Wash Station

25. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 25 Examples of Sharps Needles Syringes Surgical blades Endodontic files Burs Carpules contaminated with blood Broken glass

26. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 26 Sharps Container Red Biohazard label Puncture-resistant Leak-proof Sealed lid

27. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 27 Sharps Injury Protection Use self-sheathing needle system Use needle guards Never recap needle with two hands Use one-handed scoop method to recap Dispose of sharps in sharps container

28. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 28 Workplace Controls Wash hands after removing gloves Do not recap needles without guard Do not eat or drink in work area Food and drink should be stored away from work area Do not wear laboratory coat out of office Remove laboratory coat before eating

29. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 29 Personal Protective Equipment Includes eye protection, gloves, masks, and protective clothing Provided by employer at no cost to employee Stored at work site

30. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 30 Eyewear Wear safety glasses with solid side shields. Prescription glasses can be fitted with side shields. Face shields may be worn over glasses.

31. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 31 Gloves Must be worn when in contact with OPIM Vinyl and latex are for general use Utility gloves are for the following: –Surface disinfection –Handling sharps

32. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 32 Masks Prevents inhalation of infectious aerosols Changed after each patient or when damp

33. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 33 Protective Clothing Prevents contamination of the skin and clothes –Scrub jacket Fluid resistance Sealed cuffs Lap protection High collar Daily changes

34. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 34 Laundry Laboratory coats stored in leak-proof container with a biohazard label Laundry options –Professionally laundered –Laundered at office –Laundered at dentist’s home

35. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 35 Housekeeping Written schedule for cleaning and decontaminating worksite Contaminated work surfaces immediately cleaned Policy for cleaning equipment Barriers replaced after each use

36. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 36 Hazardous Waste Maintain chemical inventory sheet Hire hazardous waste hauler –Fixer –X-ray foil –Amalgam scrap –Vapo-sterile solution

37. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 37 Solid Waste Items contaminated with body fluids that do not drip blood when squeezed –Gloves –Gauze –Cotton rolls

38. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 38 Disposal of Solid Waste Label container with red biohazard sticker Handle with gloves Line waste container with plastic liner Dispose according to local regulations

39. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 39 Regulated Medical Waste Includes items that drip with blood –Dressings –Gauze –Tissue –Sharps Discarded by hazardous waste hauler Must be removed from office on schedule according to amount of waste generated

40. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 40 Regulated Medical Waste Container Leak-proof Labeled biohazard waste Color-coded red or orange Closable lid

41. Copyright © 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED. 41 Extracted Teeth Those that have been disinfected/sterilized are considered noninfectious waste and may be disposed.