SHARPS SAFETY

When procedures are not done carefully or correctly, or are done in haste, accidents do happen. These are common causes
of sticks, scratches and cuts in a dental office:
1. Burs left in the handpiece, sitting upright in the bracket holder.
2. Aluminum or stainless steel crowns.
. !aboratory kni"es.
#. $calers, blades, needles or other sharp instruments on the treatment tray.
%. &a"itron scaler tips which are e'posed in the field of operation.
(. Transport of instruments from the operatory to the instrument sterili)ation area.
*. $calers, e'plorers, and other instruments with sharp edges +during procedures and while processing instruments
for sterili)ation,
SAFE MANAGEMENT OF SHARPS
-$.A defines /sharps/ as any ob0ect used or encountered that can be reasonably anticipated to penetrate
the skin or any other part of the body, and to result in an e'posure incident, including, but not limited to, needle de"ices,
scalpels, lancets, broken glass, broken anesthetic carpules, e'posed ends of dental wires and dental kni"es, drills and burs.
1n this office, all sharps are to be handled in accordance with all applicable statutes.
According to -$.A2s Bloodborne 3athogens $tandard and the 244 &5& 6uidelines for 1nfection &ontrol in 5ental
.ealth &are $ettings, all recapping must be performed with a one handed method or a mechanical de"ice. .ere are the
applicable sections:
7rom the Bloodborne 3athogens $tandard:
1910.1030(d)(2)(vii)(A)
Contaminated needles and other contaminated sharps shall not be bent, recapped or removed unless the employer can
demonstrate that no alternative is feasible or that such action is required by a specific medical or dental procedure.
1910.1030(d)(2)(vii)(B)
Such bending, recapping or needle removal must be accomplished through the use of a mechanical device or a one-
handed technique.
This has been reiterated by the 244 &5& 6uidelines for 1nfection &ontrol in 5ental .ealth &are $ettings:
Work-practice controls for needles and other sharps include placing used disposable syringes and needles, scalpel blades,
and other sharp items in appropriate puncture-resistant containers located as close as feasible to where the items were
used (,!,"#,""#--""$%. &n addition, used needles should never be recapped or otherwise manipulated by using both
hands, or any other technique that involves directing the point of a needle toward any part of the body
(,!,"#,'!,""#,""(%. ) one-handed scoop technique, a mechanical device designed for holding the needle cap to facilitate
one-handed recapping, or an engineered sharps in*ury protection device (e.g., needles with resheathing mechanisms%
should be employed for recapping needles between uses and before disposal ( ,! ,"#, ""# ,""( %. +,C- should never bend
or break needles before disposal because this practice requires unnecessary manipulation. .efore attempting to remove
needles from nondisposable aspirating syringes, +,C- should recap them to prevent in*uries. /or procedures involving
multiple in*ections with a single needle, the practitioner should recap the needle between in*ections by using a one-
handed technique or use a device with a needle-resheathing mechanism. -assing a syringe with an unsheathed needle
should be avoided because of the potential for in*ury.
$tudies ha"e shown that the most common in0uries in the dental office are not caused by needles, but by instruments. -ne
common in0ury occurs as instruments are slid into bags for processing +as the instruments slide past your fingers it is easy
to be pricked through a glo"e with a scaler and8or e'plorer,, and doctors are scratched8stuck by burs left in the handpiece.
These in0uries are a"oidable by using proper e9uipment and techni9ues.
1n this office, thick utility glo"es must be worn while processing instruments, and burs should be remo"ed from
handpieces when not in use, +or the handpiece placed in a safe position so that sticks are a"oided,.
:eedlesticks are uncommon in dentistry. 1n 1;;, the &5& determined that, once the typical two handed recapping
method was replaced by a one handed recapping method, the incidence of sticks went down to an a"erage of 1 stick per
1(,444 in0ections. The sticks that do occur often occur in the mouth while gi"ing the in0ection, in which case the safety
feature would not pre"ent the in0ury. +See the "''# C+C guidelines for infection control in dentistry0 1ccupational .lood
23posures in +entistry4 ) +ecade in 5eview6, Cleveland, 7ennifer, &nfection Control and ,ospital 2pidemiology, 8ol "9,
:o. ";, 1ctober "''!, !"!-!"0 and <-reventing percutaneous in*uries among dental health care personnel6 7)+), 8ol
"#9, /eb ;;!0 "='-"!9,
-ther needlesticks can occur while disassembling the syringe. There are certain one<handed recapping de"ices that stand
the needle cap in a stable base and the syringe is recapped by inserting the syringe in the cap. $ticks may occur if the
employee isn2t careful to secure the base with one hand and carefully hold the cap on while remo"ing the syringe= the
syringe may come out of the top and the employee may be stuck by the e'posed needle.
1n this office, unsheathed needles are ne"er to be passed to employees or handled by employees. 1nstead, the doctor
administering the anesthesia must recap the needle using a one handed method or an apparatus that allows one handed
recapping. After the procedure, the capped syringe and other instruments must then be transported to the sharps container
on a tray or in a cassette, and the needle should be properly remo"ed from the de"ice and immediately placed in the sharps
container.
$harps containers are located in the sterili)ation area where the instruments are processed. $harps containers are all
labeled, closable, stored upright, puncture and leak proof, and are not allowed to o"erfill. All instruments must be
transported on a tray or in a cassette to the sterili)ation area for processing. >tility glo"es must be worn whene"er
handling needles or sharps during instrument processing, and disassembling of syringes and disposal of sharps must be
performed by the sharps container. -ur needles are plastic hub needles so that the needles can be remo"ed without
e'tensi"e hand manipulation.
-$.A prohibits the following practices with regards to sharps management:
1. $hearing or breaking of contaminated needles, blades, and other contaminated sharps is prohibited.
2. &ontaminated sharps shall not be bent, recapped, or remo"ed from de"ices. ?@&?3T1-:: &ontaminated sharps
may be bent, recapped or remo"ed from de"ices if the procedure is performed using a mechanical de"ice or a one<
handed techni9ue, and the employer can demonstrate that no alternati"e is feasible or that such action is re9uired
by a specific medical or dental procedure.
1n this dental office, sharps may be bent while administering anesthesia, because some in0ection sites are
inaccessible unless the needle is bent.
. $harps that are contaminated with blood or other potentially infectious material shall not be stored or processed
in a manner that re9uires employees to reach by hand into the containers where these sharps ha"e been placed.
#. 5isposable sharps shall not be reused.
%. 5o not pick up broken glass directly with hands. >se mechanical means, such as brush and dust pan or tongs.
(. $harps containers shall not be opened, emptied, or cleaned manually or in any other manner which would e'pose
employees to the risk of sharps in0ury.
*. 1nstruments should be remo"ed from ultrasonic cleaners and cold sterile solutions using forceps, baskets or other
mechanical means.
USE OF SAFETY NEEDLES AND SHARPS WITH ENGINEERED SHARPS INJURY PROTECTION
The :eedlestick $afety and 3re"ention Act states that:
&n addition to the e3isting requirements concerning e3posure control plans (' C/5 "'";.";#;(c%("%(iv%%, the review and
update of such plans shall be required to also4
()% >>reflect changes in technology that eliminate or reduce e3posure to bloodborne pathogens??0 and
(.% >>document annually consideration and implementation of appropriate commercially available and effective safer
medical devices designed to eliminate or minimi@e occupational e3posure??.
This office e"aluates de"ices annually, and as they are introduced into the marketplace, to see if their use will impro"e
workplace safety.
-$.A defines /engineered sharps in0ury protection/ as it applies to dental safety syringes as: A physical attribute built
into any other type of needle de"ice, or into a non<needle sharp, which effecti"ely reduces the risk of an e'posure
incident.
The Sharps Evaluation Forms are used to e"aluate sharps with engineered sharps protection on an annual basis, or any
time a new type of sharp is introduced into the marketplace +as re9uire by the :eedlestick $afety and 3re"ention Act
under -$.A,. $harps are analy)ed using these forms, their safety and effecti"eness are discussed and e"aluation and
then a summary is written and filed. These forms contain information on sharps used in the dental office, including:
1. Type and brand+s, +if known,
2. 5ental procedure+s, for which sharp is used
. Whether the sharp has an engineered sharps in0ury protection feature which is a physical attribute built into the
sharp which effecti"ely reduces the risk of an e'posure incident
#. 1f sharp has no Aengineered sharps in0ury protectionB
These e"aluated sharps will not be used in the workplace if:
1. The specific type of sharp with an engineered sharps in0ury protection feature is not always readily a"ailable in
the marketplace
2. >se of the sharp with engineered sharps in0ury protection 0eopardi)es patient safety or the success of the dental
procedure. >se of this e'ception re9uires documentation, for e'ample, a record of the dental office2s e'perience
with the sharp, or a scientific or clinical article published in a peer<re"iewed or refereed 0ournal.
. >se of the sharp with engineered sharps in0ury protection is not more effecti"e in pre"enting e'posure incidents,
as demonstrated by ob0ecti"e product e"aluation criteria. >se of this e'ception re9uires documentation, for
e'ample, a record of the dental office2s e'perience with the sharp, or a scientific or clinical article published in a
peer<re"iewed or refereed 0ournal.
#. :o reasonably specific and reliable information is a"ailable on the safety performance of the sharp with
engineered sharps in0ury protection, and the office is acti"ely determining by means of ob0ecti"e product
e"aluation criteria whether it will reduce the risk of e'posure incidents.
%. Brands of sharps with engineered sharps in0ury protection which are a"ailable in the marketplace.
(. Whether sharps were in"ol"ed in e'posure incidents, and their fre9uency of use.
The a"ailability of safety needles and other sharps with engineered sharps in0ury protection is researched through dental
0ournals, periodicals and catalogs, in9uiries of dental product suppliers and manufacturers, and "isits with dental suppliers
and manufacturers at dental meetings.
The following dental 0ournals, periodicals, lists, websites and catalogs are re"iewed: CA5A +Cournal of the A5A,, &5&
DDWE, -$.A and -$A3 +-rgani)ation for $afety, Asepsis F 3re"ention,
This dental office has regular contact with our dental suppliers and manufacturers and they understand they are to keep us
updated on information regarding safety needles and other sharps.
This dental office e"aluates safety needles, sharps with engineered sharps in0ury protection, and other engineering controls
on the basis of ob0ecti"e product e"aluation by a third party whose report is re"iewed by employees, and8or ob0ecti"e
product e"aluation by this dental office, including employee in"ol"ement. ?mployees attend annual re"iews on new
sharps technology, and employees are encouraged to submit any new technology they disco"er for e"aluation by the
office.
1n this dental office, needles with engineered sharps in0ury protection are not used. 7irst, according to our dental supply
representati"es, +because of low demand, the only safety syringe that is reliably a"ailable in the marketplace is the
$eptodent >ltra $afety 3lus @! $afety $yringe. $econdly, se"eral studies ha"e shown that safety syringes do not reduce
the incidence of sticks among e'perienced practitioners, and in fact, may increase stick in0uries because of design issues
with the product. We ha"e e"aluated the syringe and found that it does :-T meet the clinical needs of our doctors +see
attached e"aluation, and that using a traditional syringe with a one<handed recapping method is safer than using the
$eptodent syringe. +See also4 <+ental Safety :eedlesA 2ffectiveness4 5esults of a one year evaluation6, Cuny, et al.,
7)+), 8ol. "#", 1ctober ;;;0 "((#-"((9,
1n this dental office, non<needle sharps with engineered sharps in0ury protection, such as safety scalpels, blunt suture
needles, etc. are not used at this time, but are e"aluated as new technology arises.

MANAGING EXPOSURE INCIDENTS
1n this office, e'posure incidents are treated as medical emergencies and are dealt with promptly. Dedical doctors who
can pro"ide proper post<e'posure testing, followup and counseling are a"ailable at no charge to any employee who
sustains an in0ury. All in0uries should be reported immediately to the office -$.A coordinator so followup procedures
can be implemented as soon as possible.
1n this office, any time an in0ury occurs, the procedure8e"ent that resulted in an e'posure incident will be analy)ed to
determine whether any change in procedure or e9uipment will lessen the incident of in0uries in the future.
!si" St#ps to Fo$$o% A&t#r ! Sti"' In"i(#nt +a more detailed list is attached at the end of this section,:
1. 3ro"ide immediate first aid to the e'posure site by washing with soap and water +for mucous membrane
e3posure, flush with water,

2. Eeport the incident to employer. +&f there is a problem, poste3posure drug prophyla3is should be given
within an hour or two, absolutely within ( hours, to be most effective. )lso, immediate reporting allows you to
talk to the source patient while the patient is in the office so that he can be immediately sent for baseline testing, along
with the in*ured employee.,
. 5etermine the risk of e'posure and fill out an e'posure report. ++ocument the type of fluid involved, the
type and degree of e3posure, information about the source patientAs health and level of infectivity, and the health status of
the e3posed person,

#. &all the 3?3 2# hour .otline: GGG<##G<#;11 for ad"ice. This hotline is staffed 2# hours a day by medical
professionals who are specially trained to handle stick in0uries. They can gi"e e'cellent ad"ice as to what procedures
should be followed and whether the employee needs to take a prophylactic drug treatment. +Bheir advice is very helpful
because many health professionals are not very knowledgeable about dental stick in*uries and, as a result, they may
suggest drug treatment when it may not be indicated. Balking to these professionals gives some insight and information
before seeing a local health care provider.,
%. Eefer the employee to a health care professional for testing, e"aluation, followup counseling and post<e'posure
prophyla'is, if needed. The employer must pro"ide a copy of the Bloodborne 3athogens $tandard, 0ob description of the
employee, an incident8e'posure report, any a"ailable information about the source patient2s .1H8.BH8.&H status, if
known, and information about the employee2s .BH "accination status and any other rele"ant medical information.
The health care professional2s 0ob is to test the employee and the source patient +no testing of the source
patient is necessary if his ,&8C,.8C,C8 status is already known,. The physician also notifies the employee of results of
all testing, pro"ides any counseling and pro"ides post e'posure prophyla'is, if needed. .e also sends the employer
documentation that the employee was informed of all results and the need for any followup and indicates whether .BH
"accine was administered. The employer must furnish the employee with a copy of this opinion within 1% days. This
information should be placed in the employee2s pri"ate medical record and kept separate from the rest of the -$.A
materials. The employee has the right to refuse testing, or to delay testing of the drawn blood for up to ;4 days.

(. The employer must maintain all related medical records for a period of thirty years past the term of
employment.
So)r"#s !n( $in's*
www.cdc.go"
www.ada.org
www.osap.org
www.osha.go"
http:88www.osha.go"8pls8oshaweb8owadisp.showIdocumentJpItableK$TA:5AE5$FpIidK144%1 +Bloodborne
3athogens $tandard,
http:88frwebgate.access.gpo.go"8cgi<bin8getdoc.cgiJdbnameK14(IcongIpublicIlawsFdocidKf:publ#4.14( +:eedlestick
$afety and 3re"ention Act,
http:88www.osha.go"8$!T&8dentistry8inde'.html +dental topics,
www.niosh.go"
Arti"$#s*
-ccupational Blood ?'posures in 5entistry: A 5ecade in Ee"iewB, &le"eland, et al., 1nfection &ontrol and .ospital
?pidemiology, Hol 1G, :o. 14, -ctober 1;;*, *1*<*21
A3re"enting percutaneous in0uries among dental health care personnelB &le"eland, et al., CA5A, Hol 1G, 7eb 244*= 1(;<
1*G
A5ental $afety :eedles2 ?ffecti"eness: Eesults of a one year e"aluationB, &uny, et al., CA5A, Hol. 11, -ctober 2444=
1##<1##G
CDC G)i(#$in# in&or+!tion ,in"$)(#( r#$!t#( topi"s-*
A6uidelines for 1nfection &ontrol in 5ental .ealth<&are $ettings, 244.B DDWE 5ecember
1;, 244 8 %2+EE<1*,
http:88www.cdc.go"8-ral.ealth8infectioncontrol8guidelines8inde'.htm
1;; &5& Eecommended 1nfection<&ontrol 3ractices for 5entistry +DDWE, %82;8;, Hol. #2, :o. EE<G,
http:88www.cdc.go"8mmwr8pre"iew8mmwrhtml8444214;%.htm
A>pdated >.$. 3ublic .ealth $er"ice 6uidelines for the Danagement of -ccupational ?'posures to .BH, .&H, and .1H
and Eecommendations for 3oste'posure 3rophyla'is.B DDWE Cune 2;, 2441= Hol. %4 +:o. EE<11,.
http:88www.cdc.go"8mmwr8pre"iew8mmwrhtml8rr%411a1.htm
>pdated >$ 3ublic .ealth $er"ice G)i(#$in#s &or th# M!n!.#+#nt o& O"")p!tion!$ E/pos)r#s to H01 HC01 !n(
HI0 !n( R#"o++#n(!tions &or Post#/pos)r# Proph2$!/is +1nformation about hepatitis B booster recommendations
and post<e'posure prophyla'is can be found in the Appendi' section, Table <<updated .1H 3?3 info a"ailable in
/>pdated >$ 3ublic .ealth $er"ice 6uidelines for the Danagement of -ccupational ?'posures to .1H and
Eecommendations for 3oste'posure 3rophyla'is, +DDWE, ;8484%, Hol. %#, :o. EE<;,
http:88www.cdc.go"8mmwr8pre"iew8mmwrhtml8rr%411a1.htm
A1mmuni)ation of .ealth<&are Workers: Eecommendations of the Ad"isory &ommittee on 1mmuni)ation 3ractices
+A&13, and the .ospital 1nfection &ontrol 3ractices Ad"isory &ommittee +.1&3A&,.B DDWE 5ecember 2(, 1;;*= Hol.
#( +:o. EE<1,.http:88www.cdc.go"8epo8mmwr8pre"iew8mmwrhtml8444%4%**.htm
/6uideline for .and .ygiene in .ealth<&are $ettings./ DDWE -ctober 2%, 2442 8 Hol. %1 8
:o. EE<1(
http:88www.cdc.go"8mmwr8pre"iew8mmwrhtml8rr%11(a1.htm
5ate: IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII
Sh!rps E3!$)!tion o& th# S#pto(#nt U$tr! S!&#t2 P$)s XL S!&#t2 S2rin.#
+Bhe :eedlestick Safety and -revention )ct requires an annual review of any new technology that may make handling sharps more safely. Bhis is a
review of the only safety syringe that is readily available. -lease review and discuss this with others in the office and file in 1S,) notebook to satisfy
the annual review requirements. Dou may also want to evaluate safety scalpels, blunt suture needles, etc.,
5ental supply representati"es ha"e indicated that the only syringe that is still widely a"ailable is the $eptodent >ltra
$afety 3lus @! $afety $yringe, so that2s what was e"aluated. The syringe comes with an illustrated instruction sheet.
1nstructions can also be gotten from the internet or an instructional 5H5.
The syringe is made of plastic, is reusable and accepts standard carpules. 1t has a sheath that fits o"er the needle after the
in0ection is completed which easily locks into place +and it2s easy to tell when the safety feature was engaged, and the
entire needle apparatus can be remo"ed in one piece with the sheath intact so the needle stays co"ered, which reduces the
risk of a stick.
.ere are the ad"antages of the ultra safety syringe o"er a regular syringe, !""or(in. to th# +!n)&!"t)r#r: the protecti"e
sheath is part of the apparatus= pro"iding an engineering control Amakes incorrect needle recapping less likelyB
?"aluators didn2t really think that was an ad"antage o"er a traditional syringe recapped with a one handed recapping
method= none of them had e"er e'perienced Aincorrect needle recappingB and since starting to use a one handed recapping
method in the early 1;;4s, none had reported a stick in0ury from a needle +se"eral reported minor in0uries with a bur or a
solid instrument o"er the past decade,
The e"aluators agree that the de"ice did not appear to increase patient discomfort, the safety de"ice on the syringe was
easy to recogni)e and use, the instructions gi"en by the company were easy to understand, and the product could ha"e
been used without too much additional training +although the dental supply reps indicated that there is a learning cur"e
and prior studies ha"e indicated that dentists are more likely to be stuck during that time,
.ere are the (is!(3!nt!.#s according to the e"aluators: the syringe was plastic and felt AflimsyB and AunstableB while
using and loading with anesthetic carpules. All of the users felt that changing carpules was much more difficult than
changing them on a traditional syringe. $ome users with large hands didn2t feel the syringe was comfortable. $eeing
aspirated blood was more difficult through the protecti"e sheath. The hub and sheath were large and difficult to see
around, and depending on the angle of the practitioner, the needle tip and site of in0ection weren2t always "isible,
especially in a smaller mouth or one with an acti"e tongue= breath also fogged up the sheath, making it harder to see. -ut
of fourteen syringes, the sheath was accidently placed from the holding position to the locked position on two of them and
we had to get a new syringe.
Con"$)sion: The e"aluators all agreed that de"ice does not meet their clinical needs. After e'tensi"e discussion,
e"aluators agreed that the traditional syringe and a one handed recapping method was safer than using a safety syringe
because of the lack of "isibility and difficulty in loading and use. 3re"ious studies ha"e shown that most needle in0uries
occur among ine'perienced practitioners= e'perienced practitioners do not find the AsafetyB syringes to be safer and do not
intend to use them. Dembers of the dental team who break down traditional syringes are trained in methods to minimi)e
e'posure and do not report needlesticks +transport only sheathed needles and break down syringes where sharps
containers are located,
:ames of e"aluators +doctors8hygienists8assistants,: !aney Lay, C5, Lenneth ?. Lay, 5D5, Lelli $mith +dental
assistant,, 5r. CE $mith, 5D5