Infection Control

Policy on Universal (Standard) Precautions

The U.S. Department of Health of Human Services, Centers for Disease Control, has issued recommendations for the prevention or transmission of infectious diseases in dental care settings. The recommendations, called "Universal (Standard) Precautions," are based on a careful review of all available epidemiological and biomedical data. The precautions are "universal" since medical history and examination cannot reliably identify all patients infected with HIV or other bloodborne pathogens. Thus the following blood, saliva and body fluid precautions must be consistently used for all patients regardless of the perceived "low risk" of a patient or patient population.

The dental practitioner has the responsibility of adhering to infection control protocol that provides for an aseptic clinical environment. This manual addresses the concerns of Boston University and lists procedures to be followed when providing services in the BUGSDM clinics. These procedures will be continually reviewed and updated in a committed effort to provide practical guidelines to insure a safe environment for patient treatment.

In the pursuit of a vocation in the health care professions, the student assumes a routine personal risk that accompanies this choice. This risk is minimized when the practitioner adheres to the comprehensive infection control protocol outlined in this manual for all patients.

If you have any questions or concerns about infection control practices, please contact Dr. Robinson in the Department of Clinical Services at 617/ 638-5194

[Revised January 2009]

Upcoming Infection Control Lectures (PDF)

Members of the Infection Control and Safety Subcommittee

• Dr. Bruce Robinson, Chair, 8-7632, brobin@bu.edu
• Dr. Thomas Kilgore, 8-4750, tkilgore@bu.edu
• Ms. Meg Loadholt, 8-4669, megl@bu.edu
• John Alexander, 8-4753
• Maria DaSilva, 8-4032, dasilvam@bu.edu
• Andy Burke, 8-5129, yakoo@bu.edu
• Leila Joy Rosenthal, 8-4757, joyful1@bu.edu
• Mike Haddad, 4-1096
• Student Representatives: Treasurers of each class

Advisers

• Dr. Larry Culpepper, 8-8400
• Dr. Jeffrey Hutter, 8-6613, jhutter@bu.edu
• Dr. Stephen DuLong, 8-5127, sdulong@bu.edu
• Dr. John Burress, 8-8400
• Bob Burke, RN, CIC (Infection Control), 8-8815, bob.burke@bmc.org
• Eric Johnson (Safety), 8-8841, johnsone@bu.edu
• Connie Packard (Security), 4-4412
• Jim Munroe (Facilities), 8-4211

Prologue

This manual is an integral part of the institution's Exposure Control Plan. The plan is designed to minimize employee and student exposure to bloodborne pathogens including the Hepatitis B Virus (HBV), the Hepatitis C Virus (HCV), and the Human Immunodeficiency Virus (HIV).

The Exposure Control Plan is as follows:

1) A list of tasks and procedures at the Dental School has been formulated in order to identify potential for occupational exposure to bloodborne pathogens (See Table A below).

2) Based on the above list of job-related responsibilities, each employee and student has been categorized accordingly: (See Table A below ).

• Category I: At Risk
• Category II: Occasionally at Risk
• Category III: Not at Risk

3) Each employee/student who is determined to be at risk or occasionally at risk is provided an educational program with the goal of outlining and minimizing their risks to occupational exposures. In addition, the discussion includes the identification of employee/student and institutional responsibilities in controlling exposures, thus preventing injuries. This program will be offered to all employees/students on an annual basis (See Table B). The Infection Control Manual is the basic reading for this program.

4) Engineering and work practice controls have been designed to minimize exposure to bloodborne pathogens. These are described herein. Universal (Standard) Precautions shall be observed to prevent contact with blood or other potentially infectious material. The concept of "universal (Standard) precautions" stresses that all patients should be assumed to be infectious for HIV and other bloodborne pathogens. In the dental health-care setting, "universal (Standard) precautions" should be followed when workers are exposed to blood, or any body fluid visibly contaminated with blood. Since HIV , HBV, and HCV transmission has not been documented from exposure to other body fluids (feces, nasal secretions, sputum, sweat, tears, urine and vomitus), "Universal (Standard) Precautions" do not apply to these fluids unless they are visibly contaminated with blood. Universal (Standard) precautions also apply to saliva in the dental setting.

5) Personal protective equipment and its use are described in this Manual in order to minimize exposure.

6) A plan and schedule for housekeeping ensures that the worksite is maintained in a clean and sanitary condition.

7) Hepatitis B vaccination is strongly recommended for all employees at risk of exposure to blood or other potentially infectious material. Employees are required to be vaccinated for Hepatitis B or sign a declination. Consistent with Massachusetts Public Health Regulations, all students are required to be vaccinated for Hepatitis B. After vaccination, immunity must be confirmed with a Hepatitis B surface antibody test. Hepatitis B vaccination declination and HBV or HIV post-exposure evaluation and follow-up is available at Occupational Environmental Medicine (OEM), F-5. The protocol to be followed in the event of accidental exposure is found in this manual.

Personal Protection

The following recommendations are guidelines and policy for infection control in the dental clinics at Boston University Facilities: The Goldman School of Dental Medicine and the Dental Health Center.

Immunizations

Infection control policies are instituted to protect all personnel and patients from cross contamination related to dental procedures. One method to achieve this goal is for all clinical personnel (Category I & II), to be currently immunized against Hepatitis B and other appropriate diseases.

It has been shown that dental health care workers (DHCW) have a much higher rate of Hepatitis B infection than the general population. Based on studies of health care personnel, the risk of acquiring an HBV infection following a single puncture with a needle contaminated with the virus, ranges from 6% - 30%. Under similar circumstances, the risk of an HIV infection is less than 1.0%! Additionally, transmission of HBV infection from DHCW to patients has been documented. The vaccines currently used are safe and highly effective and stimulate the production of protective antibodies in at least 96% of those vaccinated. OSHA requires that Hepatitis B vaccines be offered to ALL employees at risk for contracting HBV infection, followed by Hepatitis B surface antibody testing after vaccination. These services must be offered FREE of charge.

The vaccination is strongly recommended to DHCW in Categories I & II: dentists, hygienists, assistants, laboratory personnel and other individuals who may come in contact with patients, dental equipment and prostheses during the performance of their responsibilities.

The American Dental Associations' Council on Scientific Affairs, the Public Health Service's Immunization Practices Advisory Committee and The Center For Disease Control recommend that all dental personnel involved in patient care receive the Hepatitis B Vaccination, if they do not already have immunity as a result of a previous exposure to the virus. Serological testing is required after completion of the vaccination series and should be performed four to six weeks after the last vaccination. Boosters of Hepatitis B vaccine are not needed for individuals who have demonstrated serological immunity after vaccination.

Since dental health care personnel are also likely to come into contact with many other infectious agents, vaccinations for the following are required: Measles, Mumps, and Rubella. Vaccinations for Tetanus are also recommended.

Yearly Influenza vaccination should also be considered to avoid the possibility of transmitting an infection to an older or medically compromised patient.

Tuberculosis (TB)

Plan for the Control of TB Infection at BUGSDM

1) BUDSM defers dental care of patients diagnosed with or suspected of having active pulmonary or laryngeal TB, until they are declared to be no longer contagious by their pulmonologist or the Dept of Public Health.

2) Assess each patient for a history of TB as well as for symptoms of active pulmonary or laryngeal TB.

2a) TB should be considered in all patients who present with the following symptoms: Persistent cough for > 2 weeks duration or other symptoms compatible with TB such as bloody sputum, fever and night sweats, or unexplained weight loss in addition to the aforementioned respiratory symptoms.

3) Patients suspected of active TB must leave the building as quickly as possible and should proceed to the emergency department or to the TB clinic for further evaluation.

4) Faculty and students providing clinical care will receive annual training regarding the TB Prevention Plan

Screening

According to OSHA Risk Assessment Procedures, the risk of contracting TB at BUDSM is low. Therefore, TB screening (PPD or Symptom Screen) is required only once per year for all students, staff, faculty, lab techs and other clinical personnel.

Your Immunization History

Directions: Check the appropriate column to determine your status for each of the diseases listed below:

Hepatitis B Immunization

Category I and II employees must be vaccinated or sign a declination. Students must be vaccinated. If an employee refuses the vaccine, but at a later date decides to take advantage of the safe series, he or she may do so at any time free of charge during their tenure at the institution.

The three-part Hepatitis B Vaccination series is administered intramuscularly over 6 months. It is available at Occupational Environmental Medicine (OEM) of the Medical Campus, 5th floor of the Preston Building. No appointment is necessary.

In order to avoid delay, it is important that an up to date immunization history be documented and on record at OEM. The vaccine is free to all Category I & II employees. Four to six weeks after the series is completed seroconversion must be determined. For more information, call the OEM at 638-8400.


School Policy on Patients

It is school policy that these guidelines be followed for all patients.

Medical History

Obtain a thorough medical history prior to any treatment but remember to treat all patients as potential carriers of infection from the initial to the last appointment! The medical history should be reviewed and updated at each visit. Specific questions should be asked regarding Medications, Current and Recurrent Illnesses, Hepatitis, HIV infection, Intravenous Drug Use, Multiple Transfusions, Unintentional Weight Loss, Persistent Cough, Current TB Status, Lymphadenopathy, Oral Soft Tissue Lesions, and other Infections. Consult the patient's physician as needed.

Blood, saliva, and gingival fluid from all patients must be considered infectious.

Before Patient Treatment (temporary policy to go into effect on September 21, 2005 and replaced with the permanent policy October 4, 2005)

We must ensure that all dental instruments to be used during patient care are clean and free from contamination. A temporary change in treatment center protocols will be instituted beginning September 21, 2005, and continuing until October 4, 2005. On October 4, 2005, a permanent change in protocol will go into effect. The temporary protocol is as follows:

1. Student-owned high-speed and low-speed handpieces must be returned to the dispensary window(s) by 5 p.m. the day before the student's next scheduled clinic session. Students scheduled to see a patient for an evening session appointment and also for a clinic session anytime on the next day must return handpieces to the dispensaries by 7:45 a.m. the morning after the evening session. Handpieces will be sterilized and stored in the dispensaries until required for a scheduled appointment.
2. Students who need the use of their handpieces for nonclinical purposes may request them from the dispensary, but they must be returned to the dispensary for sterilization no later than 45 minutes before the start of the next clinic session scheduled for that student.
3. All burs intended for use in the treatment of patients must be provided by the school's dispensaries. No student-purchased burs may be used in the school's treatment centers. Burs must be requested on a new form called the "anesthesia/bur request slip." This form must be signed by faculty and presented to the dispensary staff at the beginning of each clinic session in order to receive anesthesia cartridges and burs. All carbide burs, except carbide finishing burs, whether actually used or not, must be placed in the "Sharps Container" at the end of each clinic session. Diamond burs and carbide finishing burs provided in bur blocks must be returned to the dispensary at the end of the session.
4. Staff or faculty will deliver to the appropriate operatory a sealed and sterile instrument cassette with the student's handpieces after chair assignment has been announced on the sixth-floor monitor. The return of soiled instruments and handpieces will remain the responsibility of the student.

Before Patient Treatment (policy to go into effect October 4, 2005, or earlier)

We must ensure that all dental instruments to be used during patient care are clean and free from contamination. This means that all reusable instruments (for example handpieces) have been sterilized and all single-use instruments (for example carbide burs) are in original packaging. To this end, all instruments intended for use during a clinic session must be picked up together as a package from the dispensary window at the beginning of that session. School-owned instruments are clearly marked with a colored band. Student-owned instruments used for preclinical courses must not be banded so that preclinical and clinical instruments can be readily distinguished from one another and will never be commingled. The instruments referenced include:

1. Instrument in cassettes: Although students purchase hand instruments, including periodontal scalers and curettes, for use during preclinical courses, only school-owned instruments provided at the dispensary windows may be used in the school's treatment centers.
2. Burs: Bur blocks containing reusable diamond burs and carbide finishing burs will be provided at the dispensary windows in sterilized bags together with restorative instrument cassettes upon request. All carbide burs, other than the finishing burs, are considered "single use." A variety of carbide burs are stocked in the dispensary and may be requested for clinical use on the faculty-signed "anesthesia and bur slip." No carbide bur other than those provided through the dispensary may be used in the treatment centers. All carbide burs, other than finishing burs, must be discarded in the "Sharps Container" at the end of the clinic session. Diamond burs and carbide finishing burs in bur blocks must be returned to the dispensary at the end of each session.
3. High-speed and low-speed handpieces: All student handpieces must be picked up after sterilization at the dispensary window at the beginning of the clinic session. Although a student may not intend to use his/her handpieces during a particular session, no cassettes will be given to a student unless it is accompanied by the student's sterile handpieces. The protocol at the end of a clinic session requires the student to lubricate the handpieces, place them both into a sterilization bag labeled with the student's name, and return them together with the soiled instrument cassette even if the handpieces were not used. The dispensary will sterilize the handpieces and store student them until the beginning of that student's next scheduled session. Handpieces required for clinical use must be returned to the dispensary no later than 5 p.m. the preceding day. However, student sscheduled to see a patient during an evening session and also a patient the following day may return the handpieces to the dispensary by 7:45 a.m. the morning following the evening appointment.
4. When students need the use of their handpieces for nonclinical purposes, they may request them from the dispensary. However, handpieces used for nonclinical purposes must be returned to the dispensary for sterilization prior to clinical use. Minimum turnaround time for handpiece sterilization is 45 minutes .

Personal Protectove Equipment (PPE)

PPE includes the following:

1) Gloves (latex/vinyl/nitrile) A new pair must be worn for each patient. Hands must be sanitized before gloving and after degloving.

2) Mask (dome/ear loop) Must be changed for each patient (or when moist).

3) Eye Wear (face shield/goggles with side shields) Must be worn while working on patients or in the laboratory.

4) Disposable Gown. A new gown is worn for each patient. Gowns are worn inside treatment and Lab areas only. Gowns must be changed when visibly soiled. Faculty should wear a disposable gown if contamination is expected.

5) Clinic Provided Cloth Cover Gowns. Clinic provided cloth cover gowns that are laundered by the clinic and that may not be worn outside the clinic area are acceptable.

DO NOT WEAR ANY PPE OUTSIDE OF CLINIC AREAS (i.e., common areas such as elevators, staircases, cafeteria)!

Individual Cleanliness

Hair must be kept back away from the face and out of the working field. Facial hair should be covered by a facemask or shield. Jewelry must not be worn on the hands or arms during patient treatment. Hair and nails are known to harbor higher levels of bacteria than skin. Long nails are more difficult to clean and may potentially penetrate gloves. Long nails are more difficult to clean and may potentially penetrate gloves. Fingernails must be clean and extend no longer than ¼ inch beyond the pad. Do not wear artificial nails or nail extenders. No jewelry is to be worn on hands, fingers or arms. This includes rings and watches. Open toed shoes are prohibited in clinical and laboratory areas. Scrubs are acceptable as personal clothing, but should be worn with appropriate undergarments. Extraordinary care must be used when working with open flames to prevent burns.

Hand Washing Technique

Proper hand washing is probably the single most effective barrier to infection. Hands must be thoroughly and properly washed at the beginning and end of each appointment as well as before gloving and after de-gloving.

Before and after each patient treatment and after removing gloves:

• Remove all debris from hands and arms.
• Rinse hands under cool running water and apply antimicrobial soap, lather well.
• There is a 15 second minimum washing time for hands and fingers.
• Work soap around fingers and nails. Do not use a scrub brush because it may cause abrasions.
• Rinse thoroughly with cool running water (hot water opens pores and dilates capillaries).
• Dry hands with paper towels and use the towel to turn off the faucet.
• Cover cuts and abrasions with Band-Aids or finger cot until fully healed.
• If hands are not visibly soiled or sticky, they may be sanitized with an alcohol based hand rub.

Gloves

Gloves must be worn routinely while treating all patients. Refer to Handwashing Section. Gloves are restricted to patient treatment areas. Always change gloves between each patient (single use only) and discard torn, punctured, discolored, tacky, cracked or damaged gloves, as these defects will compromise the barrier protection. Hand washing after glove removal is mandatory. Never leave the operatory wearing gloves.

Latex gloves must not be washed with soap and water due to the potential of wicking of the latex and deterioration of the glove. This would pose an infection risk.

Moisturizers can be useful in counteracting the effects of dryness caused by frequent hand washing. Be advised, petroleum based products including some moisturizers can compromise the integrity of latex gloves.

Allergy to Natural Rubber Latex

Natural rubber latex (NRL) is manufactured from the sap of the Have a brasiliensis rubber tree. During the production of commercial latex, several chemicals are added. It is the proteins found in natural rubber or the chemicals in commercial latex that can cause some individuals to have an allergic reaction to latex products.

Three types of allergic reactions can occur with the use of natural rubber latex. Irritant contact dermatitis is the most common reaction to latex products. The chemicals added to NRL during its manufacture cause it. The chemicals directly injure the skin resulting in redness, swelling, dryness, itching and burning. This reaction can also occur from the powder added to latex gloves. Irritant contact dermatitis is not a true allergy and the symptoms disappear after several hours. Allergic contact dermatitis is a delayed type of immunological response resulting from the chemicals used in the manufacture of the latex product. The chemicals penetrate the skin resulting in an allergic reaction. Symptoms such as redness and swelling occur between 24-48 hours after exposure and can last for several days. This delayed type of allergic response accounts for approximately 80% of the true allergic reactions to latex. Natural rubber latex allergy is an immediate hypersensitivity response to proteins found in natural rubber latex. The response begins within minutes of exposure to the allergen (protein) and can take the form of an urticaria (hives) if exposure is through the skin, or respiratory symptoms (wheezing, runny nose, sneezing) if the allergen is inhaled. In some cases, an anaphylactic reaction (facial swelling, difficulty in breathing, and a severe drop in blood pressure) may occur if the protein is introduced directly into the blood. This immediate type of hypersensitivity or true allergic reaction to NRL is most likely to be found in those individuals who have multiple allergies and are frequently exposed to NRL products. Because of a similarity of proteins, individuals allergic to latex may also be sensitive to foods such as chestnuts, bananas, kiwi fruit and avocados. Patients should be informed of this potential cross allergenicity.

The incidence of hypersensitivity reactions to natural rubber latex has risen significantly since the late 1980s. The Food and Drug Administration attributes this rise to a ten-fold increase in the use of latex gloves by health care workers and others in response to HIV and other infectious diseases. While only approximately 1-6% of the general population is allergic to latex, the prevalence in health care workers and others whose occupations involve exposure to rubber products or require the wearing of latex gloves is around 10%. Children and adolescents with spina bifida have an incidence of between 18 and 73% because of their frequent exposure to latex products from birth.

Because of the use of latex products (e.g., rubber gloves, rubber dams, prophy cups, suction tips, orthodontic elastics, penrose drains, polishing wheels and disks, bite blocks, rubber stoppers in anesthetic carpules) in performing dentistry, a complete medical and dental history should be performed to identify those patients who have a history of latex allergy or are at high risk for being allergic (e.g. ,patients with spina bifida and health care workers). As a result of the close chemical similarity between natural rubber and gutta-percha, the material used in filling the root canal, questions have also arisen concerning its use in patients with a history of natural rubber latex. There is, however, strong evidence that the proteins found in gutta-percha are different from those causing the allergic reaction due to natural rubber latex. In addition, there is no indication at the present time that gutta-percha filled root canals poses any health concern to individuals that have a natural rubber latex allergy.

A latex allergy should also be suspected in any patient who gives a history of allergy to chestnuts, bananas, kiwi fruit and avocados, or developing symptoms such as hives, shortness of breath, wheezing, watery eyes or nasal congestion after an exposure to latex.

If a latex allergy is suspected, the patient's physician should be consulted for further evaluation.

When treating a patient with a known allergy to NRL or at high risk, certain precautions must be taken. If the patient has a history of either a delayed or immediate hypersensitivity to natural rubber latex, vinyl or nitrile rubber gloves and dams must be used. In addition, latex-free forms of prophy cups, bite blocks, etc. should be used and thought should be given to treating the patient as the first appointment in the day in order to minimize exposure to airborne particles of latex.

According to the National Institute for Occupational Safety and Health (NIOSH), workers such as health care practitioners should take the following steps to protect themselves from latex exposures and allergy in the workplace:

• Use appropriate work practices to reduce the chance of reactions to latex:
• When wearing latex gloves, do not use oil-based hand creams or lotions (which can cause glove deterioration) unless they have been shown to reduce latex-related problems and maintain glove barrier protection.
• After removing latex gloves, wash hands with a mild soap and dry thoroughly.
• Take advantage of all latex allergy education and training:
• Become familiar with procedures for preventing latex allergy.
• Learn to recognize the symptoms of latex allergy; hives; flushing; nasal, eye, or sinus symptoms; asthma; and shock.
• If you develop symptoms of latex allergy, avoid direct contact with latex gloves and other latex-containing products until you can see a physician experienced in treating latex allergy (Occupational Health Service at BU Medical Center).
• If you have a latex allergy, consult your physician or report to the Occupational Health Service at BU Medical Center regarding the following precautions:
• Avoiding contact with latex gloves and other latex-containing products.
• Avoiding areas where you might inhale the powder from latex gloves worn by other healthcare practitioners.
• Informing your faculty supervisor that you have a latex allergy.
• Wearing a medical alert bracelet.

Protective Eyewear and Masks

All dental care providers must wear proper protective eyewear while in the laboratory and treating patients to prevent injury or contamination from blood, saliva or gingival fluids and when disinfecting environmental surfaces. Glasses with protection on the top, bottom and sides are best. Solid side shields are mandatory. When anticipating aerosol exposure and/or gross splatter, a full-face plastic shield may be worn in place of safety glasses, but does not substitute for a facemask. Eyewear must be cleaned at the end of the appointment and if soiled. Disposal eyewear provided by central sterilization is intended for patient use only.

All dental care providers must wear surgical masks whenever involved in patient care. A new mask must be worn for each new patient or when a mask becomes moist or soiled. Either cone or ear-loop types are acceptable.

Protective Gowns

All dental health care providers must routinely wear disposable protective gowns to prevent exposure of the underlying skin and clean garments to blood and saliva. New disposable gowns must be worn for each patient treatment. Gowns are removed and discarded at the end of each patient treatment or when leaving the clinic area. Disposable gowns are available at the central sterilization facility and are to be picked up with other supplies. To prevent confusion, different colored gowns are worn in laboratory and clinical areas.

Environmental Disinfection

ENVIRONMENTAL DISINFECTION = SPRAY + WIPE + SPRAY

1) Wash hands as directed.

2) Wear gloves and other personal protective equipment to minimize inhalation and exposure to chemicals in the disinfectant.

3). Clean out the lines; flush water from handpiece hose and air/water syringe for 2 minutes before each patient. At the beginning of each day, flush 2-3 minutes to remove bacterial growth that may have accumulated in the lines overnight.

4) Disinfect the area. All surfaces and equipment touched by contaminated hands must be scrupulously cleaned and disinfected before seating each patient. An alternative is to use protective, disposable barriers. Disinfect the unit and surrounding area as listed below:

• Spray with disinfectant to preclean surfaces of bio-proteins. Disinfection is not effective without precleaning. Warning: Do not spray around electrical switches; use gauze soaked in disinfectant and/or barriers.
• Wipe sprayed areas clean with paper towel to remove bio-proteins
• Spray again to disinfect and leave surfaces to air dry [should remain wet for 10 minutes to get the full effect of the residual action.]
• Pre-packaged wipes soaked in Infection Control and Safety-approved disinfecting may be used. (Gloves Necessary)
• Note well: Do not use alcohol. It is not an effective "disinfectant" because it evaporates too rapidly and does not clean blood bioburden. BUGSDM provides an intermediate-level surface disinfectant [active against most bacteria, HIV, Hepatitis B and other hydrophilic viruses and TB equivalent microbes] for surfaces that are contaminated with body fluids, as well as small blood/body fluid spills. Large spills are to be cleaned up by the environmental services department.

BARRIERS [B] or LIQUID DISINFECTANT [D] are used on the FOLLOWING ITEMS

• A protective covering or barrier is an acceptable alternative for protecting items and surfaces against contamination, especially equipment that cannot be sterilized and is difficult to disinfect. Note that it is necessary to clean the surfaces at the beginning and end of each day. Otherwise, place new barriers before each patient treatment. After each treatment, remove barriers carefully with gloves in order to prevent contamination. If a surface is visibly contaminated, disinfect.

• light switches (B)
• handles (B)
• plastic protective covering (D)
• dental unit bracket tray (B)
• arm (B)
• switches (B)
• handpiece holders and hoses (B)
• base of chair and foot pedals (D)
• air/water syringe tip (disposable)
• air/water syringe (B)
• chair headrest (B)
• arms (D)
• switches (B)
• Suction system evacuation hose (D)/(B)
• saliva ejector (D)/(B)

Use the "Basic Infection Control Check List" posted in every operatory as a helpful reminder.

• Cuspidor (D)
• Counter/Sink Area faucet (D)
• handles (B)
• countertop (D)/(B)
• operator stool (D)
• shelf and cart top (D)/(B)
• X-ray view box switch (B)
• other pens (B)
• safety glasses (D)
• patient mirror (D)/(B)
• napkin chain (D)

5) Obtain disposables: barriers, tray covers, bibs, gloves, masks, headrest covers, suction tips and other items needed from the dispensary window/cart/cabinet. Take only materials necessary for each procedure. Apply barriers with clean hands.

6) Arrange unopened sterile cassettes, burs and handpieces on the bracket tray and/or shelf. Cassettes, burs and handpieces are to be opened in front of faculty giving start to insure sterility.

7) Be prepared: set up all materials, instruments, burs and equipment before starting the procedure. In this way, you limit the number of visits to the dispensary (time management) and limit the necessity to reach into your tackle box (cross-contamination management).

8) Do not introduce any instrument or equipment into the oral cavity that has not been decontaminated appropriately.

9) Place radiographs on the view box and review the chart. Avoid contact with patient charts during treatment.

10) Place chart visit sheet and daily feedback sheet in wall hanger.

AT THIS POINT THE OPERATORY IS READY TO RECEIVE A PATIENT


During Patient Treatment: Limit Contamination

Blood, saliva, and gingival fluid from all dental patients should be considered infectious.

"Universal (Standard) precautions" must be exercised at all times. Rubber dams, high-speed evacuation when using high-speed handpieces or cavitrons and proper patient positioning should be utilized to minimize generating of droplets and spatter.

Avoid contact with objects such as patient chart, telephone, instrument boxes, and carts during patient treatment unless you remove gloves or use a paper towel as a barrier. Document treatment rendered in the chart only after removing gloves. Always use college pliers/forceps to obtain additional supplies from drawers during patient treatment. Prevent cross-contamination.

Eye protection must be available for the patients. Patients must wear their own eyeglasses or be offered disposable eyewear to prevent injury during procedures. Always avoid passing anything over the patient’s field of vision. Many sharps incidents occur during dismissal of the patient or cleaning the operatory . To prevent such injury, remove potentially injurious sharps, (i.e. burs and cavitron inserts) immediately after their use.


After Patient Treatment

All reusable instruments, including handpieces, must be sterilized between every patient

Instruments: Wear gloves and protective eyewear, to rinse (not scrub) instruments in order to remove blood, tissue, cement, wax and amalgam (remove from the carrier and place in labeled containers). Carefully dispose of sharps (needles, scalpel blades, etc.) in the puncture proof containers located in every operatory.

After instruments have been rinsed and packaged for sterilization, the protective gown may be removed and discarded.

While still in the operatory and wearing gloves, fit the contaminated instruments into the cassette so that none are sticking outside of the kit. If not done correctly, this can result in puncture wounds. Close and lock the cassette. Loosely rewrap soiled cassette in original sterilization wrap and secure with tape labeled BIOHAZARD, remove your gloves, wash hands and carry cassette package to Central Sterilization. Gloves are not to be worn outside the operatory.

Air/Water Syringe, Ultrasonic Tips and Sonic Units: Must be flushed for 15-30 seconds. All tips must be cleaned, rinsed and sterilized between every patient.

Single Use Disposables: Protective barriers, suction tip, saliva ejector/prophy angle must be discarded and not reused.

Operatory: Check the area/floor for blood, splatter, debris, impression material, cotton rolls, etc. on and around the unit, cuspidor and sink. Remove contaminated barriers with gloves on. Barriers must be changed between patients. Clean and decontaminate all environmental surfaces.

Equipment: Clean and disinfect reusable equipment like the water bath, curing light, shade guides, etc.

CLEAN AND DISINFECT ALL ENVIRONMENTAL SURFACES IN PREPARATION FOR THE NEXT PATIENT


At the End of the Day

Raise the chair and place the rheostat on a paper towel on top of the seat. Warning: To prevent possible water damage, make sure that you shut off the master switch, the suction and the running water in the cuspidor. Place the black foot pedal on the rubber mat to facilitate cleaning.

Clean evacuation system by flushing with disinfectant stored for that purpose under the sink.


•EVERYTHING THAT CAN BE STERILIZED MUST BE STERILIZED!

Central Sterilization prepares, sterilizes and monitors instrument processing according to AAMI and CDC guidelines and OSHA regulations.  Staff who reprocess instruments must wear appropriate PPE for tasks that include potential for exposure to blood or body fluids.  Heavy duty gloves are worn for handling sharps; fluid resistant gowns/aprons and mask/goggles or full face shields are worn when there is risk of contaminated fluid splash.


Sterilization of Handpieces

1) All handpieces and ALL attachments (including non disposable BURS) must be sterilized after use. This includes those being sent out for repair. Slow speed motors used in combination with disposable prophy angles should be sterilized to reduce "potential" contamination.

2) Flush handpiece over the cuspidor or sink for 60 seconds to remove adherent material and oil residue. Dry the exterior of the handpiece and place in autoclave bag.

3) Important: To prevent problems with your handpiece, carefully follow the manufacturers instructions regarding lubrication and maintenance. Refer to "Handpiece Maintenance Procedures" for care of handpieces, fiber optics and attachments.

4) Use an autoclave bag and print your name, etc. using an indelible pen (not magic marker). Neatly fill out the Student Handpiece Receipt. Make sure you get the staff's signature and be sure to save your copy. It's your only proof and you will need it to claim your sterilized handpieces. NOTE: When you pick up your property, check that the serial numbers match. Don't forget to lubricate your handpieces before your next patient.

5) Handpieces must be sterilized before servicing or shipping.


Loaner Handpieces

If your own handpiece is being sterilized or is out for repair, you can check out a sterilized loaner handpiece from Central Sterilization.


Reusable Equipment and Supplies

Sign up to request supplies/equipment. Return items clean and disinfected.


Disposal of Waste Materials

The following items identified by OSHA are to be treated as "regulated waste" and must be placed in the container lined with the red biohazard bag.

• liquid or semi-liquid blood or other potentially infectious materials (OPIM) such as saliva;
• items contaminated with blood or OPIM that would release these substances in a liquid or semi-liquid state if compressed (e.g., gauze squares or cotton rolls saturated or dripping wet with blood or saliva);
• items that are caked with dried blood or OPIM that are capable of releasing these materials when handled;
• pathological and microbiological wastes.

Use, Care, and Disposal of Sharps

In addition to physical harm, emotional trauma may be a consequence of injuries sustained as a result of careless handling of contaminated sharps.

Sharps include syringe needles, scalpel blades, burs, orthodontic wires, Endodontic files and reamers, metal matrix material, suture needles, local anesthetic carpules and broken glass.

All instruments and materials classified as sharps should be handled carefully to prevent injury. All sharps must be placed in the puncture resistant sharps container located in each operatory. It is illegal to dispose of sharps in the regular trash!

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. A one-handed scoop technique, a mechanical device designed for holding the needle cap to facilitate one-handed recapping, or an engineered sharps injury protection device should be used for recapping needles between uses and before disposal. Dental Health Care providers should never bend or break needles before disposal because this practice requires unnecessary manipulation. Before attempting to remove needles from nondisposable aspirating syringes, providers should recap them to prevent injuries. For procedures involving multiple injections with a single needle, the practitioner should recap the needle between injections by using a one-handed technique or a device with a needle-resheathing mechanism. Passing a syringe with an unsheathed needle should be avoided because of the potential for injury. Consistent with CDC guidelines, BUGSDM continually evaluates new safety devices as they become available.


Local Anesthetic Armamentarium

Use a sterile syringe, a new disposable needle, and new anesthetic solutions for every patient. Since an individual patient may require multiple injections of anesthetic or other medications from a single syringe, a number of techniques can be used to minimize the likelihood of injury:

1) Use the one-handed "Scoop Method": recap the needle by laying the cap on the tray or placing the cap in a holder so that the needle can be guided into it without injury.

2) Recap the needle by holding the cap with forceps.

3) Needle Recappers are available.

4) At all times avoid operator exposure to contaminated sharps.
Disposable needles should not be purposely bent or broken; removed from disposable syringes; or otherwise manipulated by hand after use. Do not leave the syringe on the bracket tray with the needle hanging off the side.

SHARPS INJURY PREVENTION TECHNOLOGY EXCLUDED FROM USE AT BMC as of January 2007, Massachusetts Public Health Regulation 105 CMR 130.1005 (Exemptions)

Septodent Ultra Safety Plus XL last reviewed 12/16/08

Burs and Ultrasonic Scaler Tips

Remove burs from the handpiece and sonic scaler tips immediately after use. These sharp items, when not in use and placed in the holder, can be a source of injury. When the dental health care worker or assistant reaches back to the tray for other instruments, there is the potential risk that they may scratch themselves on the bur or ultrasonic tip.


Matrix Bands

When placing metal matrix bands on a tooth, a cotton roll or 2x2 gauze can be placed on top of the band when using finger pressure to seat the band. Gauze or pliers should be used when removing matrix bands.


Broken Glassware

Broken glass should never be picked up by hand. Use a dustpan and broom or a piece of cardboard to recover the broken glass. Dispose in the sharps container.


Needlestick and Sharps Exposure Protocol

If you have been exposed to potentially infectious blood or saliva via a needlestick or a sharp dental instrument, or via a splash or spill to eyes, mouth, or non-intact skin,
IMMEDIATELY:

• WASH THE AREA thoroughly with soap and water.
• If eyes or mouth are contaminated, flush vigorously with water for 15 minutes.
• NOTIFY YOUR INSTRUCTOR / SUPERVISOR.
• Complete “Manager/Supervisor’s Report” of the ACCIDENT REPORTING AND TREATMENT FORM( ART), available from your Clinic Director.
• Your supervisor should EXPLAIN THE ACCIDENT TO THE PATIENT and obtain the patient’s permission for blood testing. The patient should be asked to report to Occupational Health and Environmental Medicine for HBV, HCV and HIV testing with counseling and follow-up.
• REPORT IMMEDIATELY with the Accident Report for counseling, assessment of risk and test to:

Occupational Health and Environmental Medicine
Preston Family Building - Floor 5
Monday - Friday, 7:30 am - 4:pm
638-8400

At all other times, report to the Boston Medical Center
Emergency Room, 638-6240.

Immediate reporting is extremely important. DO NOT WAIT! If antiviral medication is indicated, it should be started AS SOON AS POSSIBLE, ideally not more than an hour or two after the exposure.

[Revised January 2009]

Radiographic Equipment

1) Use appropriate personal protection - gloves, mask, and protective eyewear when necessary.
2) Disinfect the operatory, countertop, x-ray unit, lead apron/thyroid collar, chair, controls, and doorknob before and after each patient.
3) Use protective barriers on the cylinder, tube head, chair controls, knobs and buttons on the control panel, and view box and doorknobs.
4) All Rinn instruments (bite blocks, metal arms, rings) must be sterilized between patients.


Laboratory Asepsis and Disinfection of Impression Materials

Clinic Protocol

For safety reasons, NO laboratory work is to be performed outside of BUGSDM clinics and laboratories.

All impressions and bite registrations must be thoroughly rinsed with cold running tap water as soon as they are removed from the mouth to remove saliva, blood, and debris. They must be disinfected using the appropriate techniques described below before they are either cast in plaster or stone or sent to the laboratory.

Nature of Material: Method of Disinfection

Impression compound: Rinse under cold water. Spray thoroughly with Cavicide and place in an airtight plastic bag for 10 minutes. Rinse again with cold water. Dry and pour.

Alginate (Jeltrate) impressions: Rinse, gently tap away excess water, spray with Cavicide, and place while still wet into a zip-loc bag for 10 minutes. Do NOT allow to dry. Remove, rinse, and pour immediately. Reusable trays must be sterilized.

Polysulfide rubber (Permlastic Rubber Base) impressions: Rinse thoroughly and dry. Spray thoroughly with Cavicide and place in an airtight plastic bag for 10 minutes. Rinse, dry, and pour up within 30 minutes to preserve dimensional stability.

Vinyl polysiloxanes (ExpresD, Mirror III, Reprosil, etc.) impressions; Rinse. Spray thoroughly with Cavicide and place in an airtight plastic bag for 10 minutes. Rinse again and either send to laboratory or pour at your convenience.

Polyethers (Impregum, Permadyne, Ramitec, Polygel) impressions: Rinse thoroughly with cold water and blow dry. Spray thoroughly with Cavicide and place in an airtight plastic bag for 10 minutes. Rinse well with cold water. Air dry for 30 minutes. Pour at your convenience.

For all intra-oral devices before delivery (new or repaired dentures, nightguards, retainers, frameworks): Thoroughly clean. Spray thoroughly with Cavicide and place in an airtight plastic bag for 10 minutes. Rinse well.

All prosthetic devices and appliances that are taken from the patient’s mouth (dentures, temporary crowns and bridges, permanent crowns and bridges, retainers, nightguards, etc.) must be rinsed immediately under running tap water and then disinfected appropriately before grinding, adjusting, polishing, relining, or repairing.

Grinding or polishing of such acrylic appliances must be done in the 5 th floor laboratory. Obtain burs in sterilized kits and 2 DISPOSABLE blue wheels-one for pumicing and one for polishing from Central Sterilization. Use fresh pumice for each patient, discard after use, clean and spray pumice pan with Cavicide. To remove polish, immerse appliance in a bag of “general cleaner” solution. Use 5 th floor ultrasonic machine, then disinfect and rinse again before insertion.

New appliances only should be trimmed, pumiced, and polished in the 6 th floor laboratory.

Equipment such as articulators, alcohol torches, shade guides, mold guides, and various types of knives such as Buffalo knives must be disinfected after use.

Laboratory Protocol

All materials brought from the dental operatory to the dental laboratory must be disinfected appropriately before entry. Just as impressions must be disinfected, so too must any laboratory or prosthetic materials which come into contact with oral fluids.

Metal frameworks or copings for crowns or bridges must be carefully rinsed of blood and debris and disinfected according to prescribed protocol before transfer from the operatory to the laboratory. There have been documented cases of laboratory technicians contracting serious infectious diseases including hepatitis from metal frameworks contaminated with blood. For this reason laboratory technicians appreciate documentation on the laboratory prescription that appliances have been disinfected.

Disinfection

All clinical work (Removable, Fixed, Operative) must be sprayed with Cavicide and placed in a bag BEFORE leaving the operatory and transporting the appliance to the laboratory. The appliance must be kept in the bag for 10 minutes before any work can be instituted.

Counters

Before working, cover counters with paper; after working, discard paper and clean the area. Pick up trash from floor and counters and discard. This includes the sink area!

Ultrasonic Machines

Removable: To remove tartar and stains, place disinfected appliance in same zip-loc bag with tartar-stain remover, close bag, and set into beaker in ultrasonic machine in Removable laboratory.

Fixed/ Operative: To use cement removers or general cleaner, place appliance in zip-loc bag with some of the liquid from the appropriate beaker. Use the ultrasonic machine in the Fixed laboratory.

Model Trimmers

After use, wait for the water to run clean before shutting off machine. Flush metal plate with a cup of water.

Kits

Fifth floor: Gold lathe burs for trimming acrylic are available in sterilized bags from Central Sterilization. Blue Styrofoam DISPOSABLE wheels – one for pumice and another for polish – are also obtained there. Package and return all used burs for sterilization, discard disposable wheels. Use fresh pumice mixed with disinfectant solution for each patient and discard after use. Spray pumice pan with cavacide.

Sixth floor: New appliances only that have not yet been in the patient’s mouth are treated here. Pumice and polish wheels are marked as such. Felt cones are for pumice only. Pumice requires wet wheels or cones and water in the pumice. Again, discard the used pumice. Pumice on low with no suction. Polish on low or high with suction.

Vacuspat

Make sure bowl and all surfaces of mixing blades are thoroughly cleaned to prevent cross-contamination of materials.

Needlestick and Sharps Exposure Protocol

Occupational Exposure Definition

Exposure of a dental health care worker (exposed individual) to patient's (source patient) blood by:

1) Being stuck with a contaminated needle.

2) Receiving a puncture wound from a contaminated sharp dental instrument.

3) Having the patient's saliva and/or blood come in contact with the health care worker's open wound, non-intact skin or mucous membranes.

Exposure to the patient's blood on the unbroken skin is not considered an exposure.

Protocol (excerpts from the Occupational Health and Environmental Medicine Policy and Procedure)

A. Immediately cleanses the wound with soap and water. Flush eyes or mouth vigorously with water. Report incident immediately to faculty.

B. The exposed individual (student, faculty or staff) should have blood drawn to test for HbsAb, (antibody to the Hepatitis B surface antigen), HCV (antibody to the Hepatitis C virus) and HIV (antibody to HIV virus). The individual should report to occupational health or the emergency room within hours of the exposure. Note: The HIV test is not done in the Emergency Room due to confidentiality issues. Report to Occupational Health (see insert) as soon as possible after the incident. If after hours, go to emergency room.

C. Occupational Health will counsel the exposed individual (student, faculty, staff) of the signs and symptoms of HIV seroconversion and give the individual the opportunity for counseling and clinical evaluation. An accident report and treatment form will be filled out. Note: test results are confidential.

D. NOTE: The exposed person should report to OEM (or the Emergency Department when Occupational Health and Environmental Medicine is closed) and bring the source patient as it may be difficult to get the source patient back for testing at a later date.

Hepatitis B Blood Test and Treatment Recommendations

1) If the exposed person has ever tested positive for the Hepatitis B surface antibody, no further evaluation or treatment of the exposed person for Hepatitis B is needed and no evaluation of the source patient for Hepatitis B is necessary.

2) If the exposed person is not already fully vaccinated against Hepatitis B, a Hepatitis B surface antibody test is ordered, a dose of Hepatitis B vaccine is given immediately (and the series completed as indicated), and the source patient tested for the Hepatitis B surface antigen.

3) If the source patient is known, or found to be, Hepatitis B surface antigen positive, and the exposed person has not completed a full Hepatitis B vaccination series (and is not already known to be Hepatitis B surface antibody positive), Hepatitis B Immune Globulin (HBIG) is administered as soon as possible after the exposure.

Hepatitis C Blood Test and Treatment Recommendations

1) Unless known to be already Hepatitis C antibody positive, a Hepatitis C antibody test is performed on the source patient and the exposed person.

2) If the source patient tests Hepatitis C antibody positive, the exposed person is tested for the Hepatitis C virus at 6 weeks, 12 weeks, 19 weeks and 26 weeks, and referred for evaluation by a Hepatologist if Hepatitis C infection is detected.

HIV Blood Test and Treatment Recommendations

1) Unless known to be already HIV positive, a HIV antibody test is performed on both the source patient and the exposed person. Testing of exposed persons will be performed only at OEM to protect confidentiality. When Occupational Health and Environmental Medicine is closed, testing of the source patient should be performed immediately at the Emergency Department.

2) Post-exposure prophylaxis (PEP) may be started pending receipt of the HIV antibody testing results, or if the source patient is already known to be HIV positive, using the current CDC recommended treatment protocol. Since PEP may be most effective if begun promptly, it is essential that the exposed person report immediately to Occupational Health and Environmental Medicine or the Emergency Department for evaluation.

3) Follow up of exposed persons will be conducted by Occupational Health and Environmental Medicine using the current CDC recommended testing and treatment protocol.

Further information pertaining to Infection Control and Safety in Health Care Environment can be found at the CDC website.

Infection Control

Health and Safety

Boston University School of Dental Medicine is a seven-story building constructed in 1965. It stands as an integral part of the Boston University Medical Center as it houses the staff, students, and faculty dedicated to raising the standards of dental education. The building itself is equipped with a fire alarm system, smoke detectors, heat sensors, as well as a recently upgraded sprinkler system.

Regardless of this technology, a fire or other emergency may occur necessitating building evacuation. When this takes place, the expedient, orderly and safe evacuation of the premises is critical to protect the life and safety of the occupants, as well as to allow the public safety officials to locate and extinguish the fire.

The fire and emergency procedures contained within this document outline the steps that are to be followed in the event of an actual fire emergency or when the fire alarm sounds with no readily identifiable cause. Also, the responsibilities of the fire marshals are outlined.

Do not forget that how you will react in a real emergency depends on how well you have prepared yourself before it happens. Familiarize yourself with the two exits closest to your area and react to all fire alarms in an expedient manner.

Procedure for an Actual Fire or Smoke Condition

RACE Plan

R Rescue
Remove any individual from the area of risk.

A Alert
Activate the nearest pull station
Call the control center at 8- 6666; give them the following information: Name, Location of fire, Phone extension

C Confine
Close all doors and windows in the fire area to confine fire and smoke.

E Extinguish
Use portable fire extinguisher to put out a small fire or assist you to escape a larger fire.
Evacuate
Please exit the building quickly and calmly via stairways.

DO NOT USE THE ELEVATORS. If there is smoke in the corridor or stairwell of your nearest exit, use your alternate escape route. If you must use an escape route where there is smoke, stay as low to the floor as possible; crawling lets you breathe: the cleaner air is near the floor as you move toward the exit.

Signs that identify the nearest horizontal and/or vertical routes of egress are posted. Do not hesitate in activating the alarm pull-box when you detect smoke and/or fire. The Boston University Medical Center is required by law to report all fires, regardless of size, to the Boston Fire Department. The Control Center will contact B.F.D. and initiate the response teams.

Disabled or handicapped individuals will be assisted by pre-assigned fire marshals (or staff) and their alternates. Generally, disabled or handicapped person should be assisted to the nearest safe escape exit, i.e., the inside fire exit stairway. The fire marshal will immediately notify the control center of the whereabouts of the handicapped individual. They will immediately be evacuated by the public safety official.

Please exit the building quickly and carefully. Move away from the stairs at the entrance to the building. The Boston Fire Department is ultimately responsible for determining the nature of the emergency.


The following information is a list of important number and instructions regarding YOUR own health and safety. Please read carefully.

Safety/Emergency Instructions

Emergency Contact Numbers

• 8-6666 Control Center (Emergency Number)
• 8-4144 Control Center Non Emergency Number
• 8-8830 Office of Environmental Health and Safety

Security

• 8-5000 Emergencies and immediate response to requests for assistance.
• 8-4568 Non emergency calls. (Direct connect to 1 st floor security desk)
• Employee, Student or Visitor Accident protocol:

- Call the Control Center at 8-6666.

• Administer first aid, if properly trained.
• Secure the accident scene.
• Report details of accident to your supervisor, then report immediately to Occupational & Environmental Medicine (8-8400) if the accident has occurred during work hours. Report to the ER if it has occurred after normal work hours.

Internal Disaster

Coordinate the response to an internal situation (examples include fire, bomb threat, loss of utility).

Response to a disaster:

• Remove any employees/students from areas of risk.
• Alert essential personnel.
• Contact your supervisor.
• Call Control Center at 8-6666 to get assistance.
• Contact the Office of Environmental Health and Safety at 8-8830.Natural Disaster

How to Use a Fire Extinguisher

Remember the acronym “PASS”:

P ull : Pull the safety pin on the extinguisher.
Aim: Aim the hose of the extinguisher at the base of the fire standing approximately 8-10 feet away from the fire.
Squeeze: Squeeze the handle to discharge the material.
Sweep: Sweep the hose across the base of the fire from side to side.

Laboratory Safety Guidelines

• Safety glasses must be worn at all times.
• Use proper personal protective equipment every time you work with chemicals, blood, etc.
• Shorts, open-toed shoes, and sandals are not permitted in laboratories.
• Do not store food in refrigerators used for chemicals, etc.
• Never eat, drink, smoke, chew gum, apply cosmetics, etc., in a laboratory.
• Prior to working with a chemical, always read the Material Safety Data Sheet.
• Keep chemicals in labeled containers.
• Keep eye wash station, emergency showers, fire extinguishers, and alarm-pull boxes free from obstruction.
• Keep emergency exits and all corridors free from obstruction.

Hazard Communication

As an employee, you have the right to know the hazards associated with the chemicals with which you work, and methods for protecting yourself against them. For more information on the Hazard Communication Plan please visit the Safety Website call the Safety Office at 8-8830.

Material Safety Data Sheets (MSDS)

The MSDS covers:

• Identity/chemical name.
• Hazardous ingredients.
• Physical and chemical characteristics.
• Physical hazards.
• Reactivity.
• Health hazards.
• Precautions for safe handling and use.
• Control measures.

Remember, hazard communication can protect only if YOU:

• Read the container of the substance
• Review the MSDS for additional information
• Follow all warnings and instructions
• Use the recommended protective clothing and equipment when handling hazardous substances
• Learn spill/fire and other emergency procedures
• Attend required Safety Trainings as scheduled by your administration
• Practice sensible, safe work habits

Chemical Spill

• Remove any affected personnel from the area.
• Attend to injured personnel.
• Call the Control Center at 8-6666
• Contain the spill and alert others in the immediate area.
• Before attempting to clean up spill, know what the chemical is and locate the appropriate MSDS to determine whether or not you can safely clean it up.
• DO NOT attempt to clean up a MERCURY SPILL. Call the Control Center at 8-6666

Hazardous Waste Information

The following waste materials are regulated waste and must be disposed of according to protocol.

Material Satellite Accumulation area/responsible

• Radiographic Fixer Radiology/Dr. Yanling Jiang
• Scrap amalgam 5th floor/Mr. Scott Caron
• Radiographic Film Lead Backing Radiology/Dr. Yanling Jiang
• Monomer 6th floor/Ms. Leila Rosenthal
• Sharps; Needles, scalpel blades, burs etc. Sharps Container/Housekeeping
• Blood or Saliva contaminated items Red Bags/Housekeeping

Safety and Infection Control, in conjunction with Mr. Andrew Burke, Clinical Services Manager, conduct regular compliance rounds in the Dental School on a bi-weekly basis. A different floor is inspected during each round to ensure that everything is operating on par with our standards. Any incidents of hazardous waste violations are immediately logged and reported. A Safety Office report is subsequently compiled and distributed to the responsible parties as well as presented for appropriate follow-up and review by the Infection Control and Safety Subcommittee. These measures are instated to keep the School in compliance with all applicable regulations.

Monomer Protocol

Purpose

To establish a mechanism so that employees and students use, dispose of, and store formatray monomer in a safe manner.

Procedure

• Formatray monomer will be turned into Central Sterilization on the fifth floor and stored in the chemical storage room.
• Formatray monomer will be available for use on the sixth floor in the flammable storage cabinet. The amount of monomer will be checked daily by Leila Rosenthal.
• Formatray monomer must be used, transferred, and stored in the appropriate containers.
• Unused monomer, if not recycled, must be placed in appropriate containers located in hazardous materials accumulation area on the sixth floor.
• When container is full, please call the Office of Environmental Health and Safety for a hazardous waste pick-up 8-8830.

Amalgam Collection Protocol

Purpose

To establish a mechanism so that employees and students collect and dispose of amalgam in a safe manner.

Procedure

• All waste amalgam must be placed in the container that is provided at the triterators, in the appropriate bays, and in the lab facilities.
• When container is full, call the Office of Environmental Health and Safety at extension 8-8830 to report a hazardous waste pick-up.
• The catches / traps will be replaced on an as needed basis by the staff when they perform their weekly check. On completion of their weekly amalgam trap preventive maintenance they are to fill out the log sheet Amalgam Trap Form located in a red binder in the dispensary area for that floor
• Location (s) of the Amalgam Trap Preventive Maintenance Log Book are
  • Seventh floor room 703
  • Sixth floor room 604
  • Fifth floor room 521
  • Second floor room 206
  • First floor room 103.
• These catches / traps will be placed in a five gallon container which will be stored in the Dispensary area. When container is full, a call is to be placed by the staff in the dispensary to the Office of Environmental Health and Safety to inform them of the need to have the hazardous waste pick-up and disposed of to comply with the applicable regulatory requirements
  

General Information

Please help keep BUGSDM in good condition. If you see any of the problems listed below, please call one of the following departments or individuals for assistance:

1. Facilities/Operations: Control 8-4144

• Air Conditioning/Temperature Regulation
• Ceiling Tiles
• Clogged Sinks
• Lock Mechanism Repair
• Overhead Lights Out
• Spills
• Trash Removal/Overflow
• Water Leaks

NOTE: When you call CONTROL, please identify yourself, location (Dental School, "G" Building, Room Number) and describe the problem as best as you can. To identify bench/sink location, use the black decal number.

2. Security: 8-4568 (stolen, lost or found items (handpieces, handbags) etc. Security: 8-5000 (suspicious persons in or around the building

NOTE: Call security as soon as possible to report an incident.

3. Office of environmental health and Safety: 8-8830

• Chemical Spills
• Odor Complaints

4. Dental Equipment. Contact: Dental Repair via cc mail (Repair, Dental). All Dental equipment in the labs, clinics, plaster and casting rooms, i.e.:

• Handpiece Air/Water Hose Attachments
• Rheostats
• Vibrators
• Wheels

NOTE: Dental repair can also be contacted at the Central Sterilization Desk on the Fifth and Second Floors. Record requested repairs by providing information be specific, include: room and bench decal numbers to identify location.

5. Paula Linsky, Supply Room: 8-4668

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