Infection control: personal protective equipment.

Dentists are regularly challenged to identify land use processes and equipment that protect employees from occupational hazards. Injuries involving contaminated needles and other sharps are of particular concern.

The Centers for Disease Control and Prevention estimate that healthcare workers annually sustain nearly 600,000 percutaneous injuries involving contaminated sharps. In response to both the continued concern over such exposures and the technological developments that can increase employee protection, Congress passed the Needlestick Safety and Prevention Act. The Act directed the Occupational Safety and Health Administration (OSHA) to revise the bloodborne pathogens standard to establish in greater detail the requirements that employers must identify and make use of appropriate, effective, and safer medical devices. Compliance with these requirements must be documented in a facility's written exposure control plan.

In the past, protecting employees from bloodborne pathogens primarily involved personal protective equipment (PPE), such as gloves, masks, and protective eyewear. Although PPE is an essential component of infection control and occupational safety, it is not considered a first-line defense against exposure. For example, wearing gloves does not fully protect employees against needlestick accidents. OSHA has indicated that engineering, work practice, and administrative controls must be used to eliminate or reduce employee exposure. If occupational exposures remain after the application of controls, PPE should also be used.

Engineering controls isolate or remove a hazard from the workplace. Examples include sharps disposal containers, self-sheathing needles, safer medical devices (such as sharps with engineered sharps injury protections), and needleless systems.

Work practice controls reduce the likelihood of exposure by altering how tasks are performed. For example, prohibiting two-handed recapping of contaminated needles is a work practice control. Work practices involve training employees to perform tasks in ways that reduce their exposure to workplace hazards.

Sometimes considered part of work practice controls, administrative controls involve changing how or when employees do their jobs. An example would be rotating employees to reduce exposures.

Although the practice of dentistry does not easily lend itself to administrative controls, changing the timing of some tasks could reduce the number of employees who are potentially exposed to a hazard.

Employers must assess their workplaces to determine if hazards are present that require the use of PPE. If a hazard, such as bloodborne pathogens, is present, then the employer must select PPE and require employees to use them. Involving employees in the selection process can improve compliance.

PPE must fit properly, and employees must be trained to use it correctly. Employees also should know when to use PPE, what kind of PPE is necessary, the limitations, and how to effectively maintain the PPE. Employers must provide PPE to employees at no cost. Employees in turn must properly and consistently use PPE.

An employer's first line of defense against exposure to occupational hazards should be engineering and work practice controls. Successful selection and use of PPE can further enhance the level of safety.

Reprinted with permission of Dental Economics, Feb. 2003, copyright [c] 2003.

Dr. Charles John Palenik is an assistant director of Infection Control Research and Services at the Indiana University School of Dentistry. Dr. Palenik has authored numerous articles, book chapters and monographs, and is the co-author of the popular Infection Control and Management of Hazardous Materials for the Dental Team. He serves on the Executive Board of OSAP, dentistry's resource for infection control and safety. Questions about this article or any infection control issue may be directed to [e-mail].