Ask the expert: Passing the buck and the needle on disposal practices

By: December 23rd, 2011 Email This Post Print This Post

Q: Who is responsible, the dental assistant or dentist, for the disposing of a contaminated needle in the sharps container?

A: OSHA’s Bloodborne pathogens Standard 1910.1030(d)(2)(i) says:

Engineering and work practice controls shall be used to eliminate or minimize employee exposure.

I believe the unnecessary handing of a contaminated sharp, even with the safety mechanism engaged, by a dental assistant constitutes a work practice that increases the chance of exposure.

This is supported by OSHA’s Enforcement Procedures for the Occupational Exposure to Bloodborne Pathogens which says:

Preventing exposures requires a comprehensive program, including the use of engineering controls…and proper work practices (e.g., no-hands procedures in handling contaminated sharps, eliminating hand-to-hand instrument passing in the operating room).

Is there a patient safety reason for the dentist not disposing of the sharp. If not, I’d say having the dental assistant unnecessarily handling the contaminated shard is a likely OSHA violation.

What do you think, is this a standard or unsafe work practice. Let us know in the comment section below.

Comments

This reasoning is unsupported by the reality of the way dental syringes are handled. Once the needle is capped, it is no more dangerous to handle than any other sharp instruments on the tray. In fact, it is less dangerous By this reasoning the dentist would need to carry the tray of contaminated instruments, place them in the ultrasonic cleaner, etc., etc. And, so, what are the assistants duties?

OSHA’s Bloodborne Pathogens Standard (like most government regulations surrounding health care) concentrates more on medical procedures than dental procedures. Dental assistants handle numerous types of contaminated sharps during operative procedures, including setting up, breaking down & decontaminating operatories, and cleaning/sterilizing/disposal of various types of contaminated sharps. A lack of understanding of the role of dental team members is apparent here. The only way to eliminate employee exposure for dental assistants is not to employ dental assistants – Not an option. Instead, dental auxiliary employees are trained yearly on how to handle & dispose of sharps as well as a yearly review of potentially safer sharps on the market. Expecting dental assistants not to handle contaminated sharps, including needles, is tantamount to prohibiting nurses from giving injections.

To “snail”
Well said. If you want infection control guidance specific to dentistry, your best bet is osap.com.

In dentistry we recap needles using a recapping devise or 1 handed scoop method for a medical reason, to achieve the correct level of anesthesia. As snail said in the first blog, once recapped the needle is safer than the other reusable sharps on the tray. There is more hazard from transporting the reusable sharps(instrument) to the sterization area on a tray or in a cassette with holes. These must be transported in a puncture-resistant, leak-proof container. Most offices are not using proper container and they are at risk for a citation for this recognized hazards.

Using the reasoning that the assistant should not handle them is impractical not only in dental offices- let’s visit the OR. Using the reasoning above, we would then need to require the surgeon to leave the table (breach in sterile technique and prolonged anesthesia time for the patient) to dispose of their own needles, suture needles, scalpels, etc. This is the job of the scrub tech who is also educated in safety procedures. Again, we need to look not only in theory but the overall encompasing practices of what happens. Sorry David, usually you offer great advice but you are off base on this one.

By suzanne reilly,RDH on December 30th, 2011 at 11:53 am

Education; training; evaluation of new devices; education; training; evaluation of new devices; education; training; evaluation of new devices……

Sorry, but I gave the wrong address for OSAP. It is osap.org for guidance about infection control specifically targeted for dental offices.

Also, the CDC Guidelines to Infection Control in Dental Health Care Settings.
http://www.cdc.gov/oralhealth/infectioncontrol/guidelines/index.htm

By michael schaffer on December 13th, 2012 at 8:14 am

a dental needle is never recapped,as the butt,boot or back end is just as contaminated and dangerous as the front. it is conveniently ignored by regulators,clinicians and manufacturers,and can stick anyone,even after insertion in the sharps box. bent and angled needles as well as intraligamental syringes almost impossible to protect,also ignored by the “experts” no safe way to protectcontaminated needles between injections,and if anyone has the brass to think it is,then the earth is flat. no manufacturer assures that the cap won’t fall off as not meant to be reinsertred. know you heardit all before,but if i note the dangers,also have all the solutions except a flailing patient,no one does. uspto thought it original enough to grant 2 patents

 

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