User:Sweet-tooth/sandbox

== Sharps Injuries: ==

Due to the nature of their work and the instruments used, both dentists and dental nurses are at great risk of sharps injuries. This is a common occurrence in the dental field yet almost entirely preventable with the correct protective equipment and procedures. A sharps injury could be caused during any Exposure Prone Procedure (EPP), where the healthcare worker’s gloved hands may be in contact with sharp instruments, needle tips or sharp tissues (e.g. spicules of bone or teeth). This may be inside a patient’s open body cavity, wound or confined space in which the fingertips may not be completely visible at all times. Most dental procedures are EPP’s except:
 * Examination using only mouth mirror
 * Taking extra-oral radiographs
 * Visual and digital examination of the head and neck
 * Visual and digital examination of edentulous mouth
 * Taking impressions of edentulous patients
 * Constructing and fitting full dentures

With sharps injuries there is an associated risk of transmission of infections, such as blood borne viruses e.g. hepatitis B virus (HBV), hepatitis C virus (HPC) and human immunodeficiency virus (HIV). It has been shown that there is great emotional impact related to sharps injuries, even if there has been no transmission of infection. This may be due to the extensive process following a sharps injury, embarrassment, or fear of being exposed to infectious disease. The estimated percentage risk of transmission of these viruses is outlined in the table below:

Other infectious agents which can spread by this route are:
 * Viruses: Cytomegalovirus (CMV), Epstein-Barr Virus (EBV), Paroviruses
 * Bacteria: Treponema pallidum (syphilis), Yersinia, Parasites, Plasmodium

Legislation:
The “Health and Safety (Sharp Instruments in Healthcare) Regulations 2013 was published by the The Health and Safety Executive (HSE) and is aimed at healthcare employers and employees. The Sharps Regulations build on the existing law outlined in the European Council Directive 2010/32/EU, which requires employers to carry out risk assessment of sharps injuries and practice adequate control measures. The regulations are based on preventative control measures set out in the Control of Substances Hazardous to Health Regulations (COSHH), with additional measures:
 * Avoid unnecessary use of sharps: - Only use them as required
 * Use safer sharps with mechanisms to prevent or minimise risk of injury e.g. needles with protective shield, and avoid re-sheathing needles
 * Place secure containers and instructions for safe disposal of medical sharps close to the work area: Instructions for staff on safe disposal of sharps must also be placed in those areas
 * All employees must have access to information on: safe operating systems, risks from sharps injuries, legal duties, prevention, vaccination, support.
 * Employees must be properly trained to use and dispose of sharps safely
 * Injured employee’s duty to notify their employer of a sharps accident
 * The incident must be recorded fully and investigated. An entry in an incident book must include:
 * Who was injured
 * When they were injured
 * Type of procedure carried out at the time
 * Severity of injury
 * Employer must ensure injured employee is treated and followed-up
 * Review procedures regularly

=== Prevention: ===

Practical ways to prevent sharps injuries include: There are various needle stick injury prevention devices available for use in routine dental procedures. One example is of a single use syringe barrel which removes the risk of re-sheathing a needle as there is a plastic shield which slides down to safely cover the sharp point. A second “click” locks the cover in this place to avoid accidental uncovering of the needle.
 * Never passing instruments of a patient’s face
 * Removing burs from handpieces when not in use and checking their safety before use
 * Keeping the bracket table tidy
 * Handling sutures with suture needles only
 * Using needles with safety devices

Management:

 * Account for and make safe the instrument responsible for the injury
 * Encourage free bleeding of the skin wound. Cleanse with soap and water, followed by 70% alcohol. If the damaged area is a mucous membrane, rinse immediately and thoroughly with water or saline solution.
 * Report incident to person responsible for occupational hazard incidents
 * Someone unrelated to the accident should carry out a risk assessment
 * If the source of the blood is known, inform them and request permission to take a blood sample for HCV and HIV test. If permission is refused, it must be assumed that they are a carrier.
 * Take baseline blood sample from the injured healthcare worker as soon as possible after the incident
 * Further blood samples should be taken after one, three and six months

Incidents with higher risk of virus transmission are those associated with:


 * 1) Deep wounds
 * 2) Visible blood on instrument
 * 3) Hollow bore needles containing blood
 * 4) IV or IM injection of contaminated blood
 * 5) Blood from a patient with a high virus level (e.g. untreated or end-stage AIDS patients)