If an exposure incident happened, would you be prepared?

May 1, 2011
Although exposure incidents happen infrequently in dentistry, they can have serious consequences. Would you and your team be prepared to deal with an incident if one occurred in your practice?

Mary Govoni, CDA, RDA, RDH, MBA

For more on this topic, go to www.dentaleconomics.com and search using the following key words: infection prevention, exposure incident, post-exposure testing, high risk, Mary Govoni.

Although exposure incidents happen infrequently in dentistry, they can have serious consequences. Would you and your team be prepared to deal with an incident if one occurred in your practice? The OSHA Bloodborne Pathogens Standard requires that you have a written plan in place, and that you provide appropriate medical care for an injured employee. Let’s discuss what constitutes an exposure incident and what a plan should include.

According to OSHA, an exposure incident is a cut, puncture, or percutaneous injury with an item that has been contaminated with blood or other potentially infectious materials (OPIM). An exposure incident may also occur when blood or OPIM is splashed or spattered onto nonintact skin or mucous membranes.

Translation: A cut or puncture with a contaminated instrument, needle, scalpel blade or other sharp item; or spatter of blood or saliva into the eyes, nose, or mouth or onto hands with cuts or abrasions. The former is the most likely scenario, happening when needles are recapped improperly or instruments are being prepared for cleaning and sterilization. The latter is not likely to occur if the dental professional is wearing appropriate personal protective equipment.

If an injury occurs, the Centers for Disease Control and Prevention recommends that the affected area be washed and a skin antiseptic (such as alcohol) be applied. If the incident involves spatter in the eye, the eyewash station should be used immediately to remove any debris from the eye.

Next, the employee should report the incident to the designated OSHA manager for the practice or facility. The name of the employee, date of the incident, and other pertinent information should be recorded on an incident report form. OSHA requires that the patient be informed and asked to submit to blood testing to determine if the employee was potentially exposed to hepatitis B or C, or HIV/AIDS.

The patient may refuse testing and this should be recorded on the incident report form. The employee may also refuse post-exposure testing. If this occurs, the employee must sign a declination form that states that he or she refused to be tested. But the employee may choose to have blood drawn and saved for testing for up to 90 days.

It is in the best interest of all the parties involved if the patient and employee (or doctor) are tested in the case of an exposure incident. Although OSHA does not require the employer to pay for the patient testing, the employer is responsible for the costs associated with testing the employee and any necessary post-exposure treatment.

These costs, including patient testing in some cases, are covered by workers’ compensation insurance. The most efficient method of handling the post-exposure testing is to send the patient and employee to the same facility, where blood can be drawn, rapid HIV testing can be performed, and the appropriate counseling treatment can be provided to the employee if necessary.

Most communities have occupational medicine clinics or practices where testing and follow-up can be provided. If such a facility is not available in a small community, the nearest hospital emergency room would be appropriate.

Immediately after the incident, but before a patient and employee are sent for testing, the facility should be contacted and a medical professional consulted regarding the incident. In some cases, the incident is not considered a high risk for exposure and the medical professional may not recommend testing and treatment.

But leave that decision to the medical provider; don’t assume that risk as the dentist/employer. If the medical provider recommends testing, it should be done immediately. Waiting until the end of the workday may put the employee at risk. If by remote chance the patient is HIV or AIDS positive, the post-exposure drug protocol is most effective within the first two hours after exposure.

When an incident occurs, panic is a common reaction. Having a written plan to follow can be a great help in allaying fears and reducing the confusion of not knowing what to do. Of course, prevention is always the best medicine.

Wearing the appropriate protective eyewear, face masks, and exam gloves when appropriate helps prevent splash exposure. Proper recapping of needles, including the use of recapping devices, if desired, and always wearing puncture-resistant utility gloves when handling contaminated instruments are good insurance policies against exposure incidents. Be prepared. Draft or update your exposure incident plan today.

Mary Govoni, CDA, RDA, RDH, MBA, is the owner of Clinical Dynamics, a consulting company based in Michigan. She is a member of the Organization for Safety, Asepsis and Prevention. She can be contacted at [email protected].

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