BIO-HAZARDS IN DENTISTRY

Some things to think about…. Do you consider infection control

and cross contamination during lab procedures ?

Do you know how you should dispose of waste from the office ?

MAGNITUDE OF THE PROBLEM CAUSED BY BIO-HAZARD WASTEGLOBALLY : Developed countries generate 1 to 5 kg/bed/dayDeveloping countries : Meager data, but figures are

lower. 1-2kg/pt./dayWHO Report : 85% non hazardous waste

: 10% infective waste : 5% non-infectious but hazardous

( Chemical, pharmaceutical and radioactive )

INDIA : No national level study Local or regional level study shows

hospitals generate roughly 1-2 kg/bed/day

Classification of Waste

Because dental offices use substances that may be federally, state, or locally mandated, it is important to understand the types of waste for proper disposal.

OSHA regulates waste within the dental office since their primary function is to protect the employees.

The EPA regulates the disposal of waste as soon as it leaves the dental office.

Regulated Waste Defined as waste that “requires special

handling, neutralization or disposal.” Includes all “sharps” such as disposable

needles, scalpel blades, broken glass, burs, endodontic files and reamers.

Also includes blood and blood soaked or blood-caked items, human tissue, extracted teeth, and waste from pathology procedures.

Regulated waste requires special disposal in biohazard containers or bags. Dental offices should contract with licensed carriers to dispose of this waste.

Non-regulated Waste Non-regulated waste includes items such

as used patient bibs, barriers used during treatment, and saliva soaked gauze.

If this waste contains potentially infectious materials, even if it is considered non-regulated, it should be labeled with a biohazard label.

Bio-hazardous Waste

Bio-hazardous waste shall be considered capable of producing an infectious disease if

It has been, or is likely to have been, contaminated by an organism likely to be pathogenic to healthy humans.

If such organism is not routinely and freely available in the community.

Such an organism has a significant probability of being present in sufficient quantities and with sufficient virulence to transmit disease.

Transmission Of Infectious Agents In All Settings Requires 3 Interrelated Elements

TRIAD

Source

Mode of Transmission

Susceptible Host

Why Bio-hazardous waste is hazardous ?

Infectious waste is capable of producing an ‘ Infectious Disease ’. This depends on factors like Dose Host susceptibility The presence of a pathogen The Virulence of a pathogen The portal of entry (most commonly

absent factors)

LAB PROCEDURES

Prevention of cross-contamination is important in the dental laboratory setting.

Cross-contamination can occur between the dental office and the dental lab and visa versa.

Proper handling of lab materials can prevent this occurrence.

Work practice controls that would prevent cross contamination should be employed both by the dental office and the lab.

Dental personnel must remember that after any equipment or product is used in the mouth it is contaminated. Consequently, it is a potential source of cross contamination.

If a contaminated item happened to be sent to the lab, the lab technicians could unknowingly contact potentially infectious materials themselves, or could spread these materials from one patient’s lab case to another.

PART I

Splatter and Aerosols

PART II

Infections

If a dental impression must be shipped and has not been disinfected, federal regulations state that they must be labeled with a biohazard label.

It must also be closed before it can be shipped, stored, or transported (even just to the local lab)

The best alternative is to properly disinfect patient items before they leave the office.

PART III

Procedures forClean

VsContaminated cases

An Example of

Lab case labeling

to provide clear communication between lab and dental office.

PART IV

Sterilization

Dental lathe without shield

SterilizedRag Wheel

Properties of Waste Disposal Containers

Leak Proof Labeled Accessible Maintained Upright Puncture Resistant Closeable

How to comply with the New Management Standards

There are three major factors which help in complying with the new management standards

Ease Efficiency Economy

Dental Impressions Dental impressions should be disinfected as

soon as possible after they are removed from the mouth. Ideally, disinfection procedures should be performed chairside.

You should first rinse the impression to remove visible debris, and then disinfect using an EPA-registered intermediate level disinfectant. Remember to follow the instructions for “kill time”. Following disinfection, rinse thoroughly with water.

Consult the manufacturer’s directions concerning which disinfectant is appropriate for each type of impression material

References

Miller, C. H., & Palenik, C. J. (2005). Infection control and management

of hazardous materials for the dental team (3rd ed.)

St. Louis, Missouri: Elsevier/Mosby. OSAP (2004). From Policy to

Practice: OSAP’s Guide to the Guidelines. Annapolis, MD: OSAP.

THANK YOU