Cases

*Part One: OSHA’s Bloodborne Pathogens standard (29 CFR 1910.1030) Meets COVID-19 (SARS-CoV-2) Case Study
Purpose: To understand the implications and purpose of the Bloodborne Pathogens standard, Waste Management, and how these apply to dentistry. To identify both biological and chemical hazards found in the dental office and how to implement the requirements and recommendations involving potential hazards exposed to dental team members.
Who is your Audience? Imagine you are the Infection Control Lead in a dental office. Your goal is to educate staff of OSHA, BPS, and CDC practices to protect yourself, the dental team and our community. Your classmates will also learn from you and your efforts to recognize safety concerns. Provide your readers with concrete facts, not your opinion. You are evolving to be a leader in dentistry! 
Required Reading to Complete the Assignments: Chapter 19 and Internet Resources listed 
below will assist you as you proceed to complete both Part One and Part Two. These resources 
will also provide great insight as you move forward in your dental assisting education and 
career. I highly recommend you save these sites as “Favorites” or Bookmark them. 
Quick Reference Guide to the Bloodborne Pathogens Standard
https://www.osha.gov/SLTC/bloodbornepathogens/bloodborne_quickref.html
Bloodborne Pathogens and Needlestick Prevention
https://www.osha.gov/SLTC/bloodbornepathogens/index.html
Interim Infection Prevention and Control Guidance for Dental Settings During the COVID-19 Response
https://www.cdc.gov/coronavirus/2019-ncov/hcp/dental-settings.html
Hazard Communications
https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=10099
 
Hazard Communication Safety Data Sheets (Quick Card)
https://www.osha.gov/Publications/HazComm_QuickCard_SafetyData.html
Hazard Communication Standard: Labels and Pictograms
https://www.osha.gov/Publications/OSHA3636.pdf

*Directions: Read the Case Study below. Identify any Hazard Communication violations/problems that contradict CDC recommendations and OSHA, and Bloodborne Pathogen Standard requirements. After you identify the concern, provide the correct procedures or protocols and support this correction with a rationale. Remember, the dental assistant is in a position of authority as a responsible team leader that manages Infection Control Prevention and Safety.
*Example:
1. Problem: With a contaminated gloved hand, the dental assistant (DA) scratched her
eyebrow.
Correction: Remove contaminated gloves, perform hand hygiene then scratch her eyebrow.
Rationale: In a contaminated zone, DHCW should never touch any unprotected body part. To reduce transmission of any pathogen, removal of the contaminated glove and performing hand hygiene follows CDC and Bloodborne Pathogen standards.
Case Study: Current Time 2020.
The receptionist texted Mr. Hersh to come to the reception area because the clinical team is ready. Mr. Hersh arrived then the dental assistant (DA) brought him to treatment room B. The DA confirmed Mr. Hersh was getting a composite filling on his lower right molar.
Mr. Hersh indicated that he has not been feeling well for the several days, “It’s hard to breathe sometimes”. The DA said, we will keep you in an upright position and work quickly but safely to get you home.
Because the procedure will produce bio-aerosols, both the DA and dentist donned (placed) their personal protective equipment (PPE) in this order: nitrile examination gloves, face shield, surgical mask, and disposable gowns. During the procedure, the patient required more local anesthetic to be comfortable. The dentist removed the cap from the needle/syringe, handed the cap to the assistant. The DA placed the cap on the counter. When done administering the anesthetic, the dentist handed the syringe to the DA. She carefully recapped the needle with two hands to avoid getting punctured. The DA disassembled the needle from syringe then disposed the needle in the contaminated waste basket.
During the procedure, the DA’s face shield began to fog up and she could not see to assist the dentist. She slightly lifted the face shield to defog her shield and she was able to resume assisting. To keep the dentists’ instruments clean during the procedure, he asked that before he uses it again for the DA saturate with any material to keep it clean. She chose to saturate cotton/gauze with alcohol to remove smudges and or particles. The dentist appreciated her keeping the instruments clean.
The patient did very well without complications. While the DA removed the patient napkin from Mr. Hersh then disposed in the contaminated waste container, the dentist doffed (removed) his PPE in this order: examination gloves, shield, mask, gloves, and gown. He then washed his hands for 5 seconds then escorted the patient to the reception area.
The DA began to clean and disinfect the treatment room. She was wearing all her PPE but replaced her face shield her prescription glasses. She collected all items that had visible blood and placed in the biohazardous waste container. She couldn’t remember if the container needed a red liner and universal biohazardous waste symbol. It had been 3 years since the office had OSHA training. She continued to clean and disinfect the surfaces that were contaminated. The disinfectant solution splashed into her right eye. She didn’t know what to do! The spray bottle did not have a label of any kind. Her eye wasn’t really bothering her, so she didn’t think much more about it.
****Here is the DA. Can you identify any PPE concerns?