Hiding in plain sight

Steve Ashton considers some risk areas in dental practice so obvious they become invisible.

DENTISTRY isn’t especially high risk. Most of the things that cause injury or ill health are reasonably well understood within the profession. With a little bit of thought and effort, appropriate controls can be used effectively. The problem generally isn’t that the issues are not obvious; it’s that they’re so obvious those working in the environment day-to-day tend not to think about them. People become complacent and oblivious to risks that only seem obvious with hindsight in the aftermath of an incident.

Slips, trips and falls

This is the easiest place to start in any workplace and is the most overlooked area of danger, causing injury (and sometimes death) to thousands every year. Patients, visitors and staff walk into the practice every day. How often have you seen the damaged tiling just inside the entrance and promised yourself you would do something about it “tomorrow”? How oft en has the splash of coffee at reception been left to dry on the floor instead of being immediately mopped away? It is so obvious it seems unnecessary to even think about. But therein lies the problem.

If your practice does not have a culture embedded in the mind of every employee to recognise and to do something about the small problems that arise each and every day then, sooner or later, somebody will slip or trip. And the outcome can be serious. While the most likely consequence may be bruised pride, slip, trip and fall incidents in the UK cost 40 workers their lives in 2009 and cost society an estimated £800 million each year. In addition to the fatalities, there were over 15,000 major injuries attributed to this single hazard.

A well-planned inspection programme will help you to remove the “blinkers” and control the most obvious hazards that may otherwise go unrecognised and unresolved. A fresh pair of eyes (sharing the inspections with someone from another practice, for example, or bringing in a consultancy) may see far more where familiarity has created blind spots.

Infection control

This is a key risk area for the dental profession. Very high standards of cleanliness and scrupulous procedures for disinfection in the surgery are (quite rightly) expected and (generally) achieved. The need for inoculation against hepatitis (and to confirm the effectiveness of the treatment) for anyone undertaking invasive procedures is generally well understood.

But when was the last time you reminded ancillary staff that they should stay away from work when suff ering from a simple head cold or perhaps a stomach upset? Are your reception staff aware of the standards expected or are they waiting at the desk with a welcoming sneeze for all the incoming patients? Are your domestic cleaners routinely disinfecting the taps in patient area washrooms or are they leaving a trap for the unwary?

If your standards are not communicated effectively to everyone in the business there could be a risk of disease transmission. The British Dental Association (BDA) recognises that all members of the dental team have a responsibility to follow infection control guidelines to ensure safe practice. They have published detailed guidance, including topics such as surgery design, cleaning and disinfection. In addition, the Department of Health has published a technical memorandum on decontamination. These should be translated into clear, simple policies and staff guidance written in language your whole team can understand.

Gas scavenger systems

Following the cessation of general anaesthetics in dental practice there has been an increase in the number of practices offering relative analgesia.

It is important that gas scavenging systems are properly serviced and maintained to prevent leakage and transient escape into the working space. Exposure to nitrous oxide gas for patients is intended to be at (relatively) high concentrations for short periods of time. Exposure for staff at much lower concentrations for prolonged periods has a completely different impact – which may cause problems especially for staff of childbearing age who could be at increased risk and whose potential exposure must be assessed and managed appropriately.

Skin problems – occlusive gloves

How well do you manage skin care measures in your practice? Have you or any of your staff suffered problems from itching, flaking and reddening skin? Have you ever even asked the question? Severe allergic reaction to the wearing of natural rubber latex gloves is (thankfully) now far less common than it used to be as manufacturers introduce ever-safer unpowdered, low-free-protein formulations. Nitrile and vinyl gloves are available that are suitable for some tasks but even these can cause allergic skin reactions for some people and are certainly not the answer for all applications.

Perhaps the bigger problem – the one more commonly overlooked – is the need for a good skin-care regimen whatever glove is worn. Wearing any impermeable (occlusive) glove for prolonged periods can cause hyperhydration and a predisposition to subsequent skin problems including infection and/or physical damage. The science of skin care is developing rapidly. How much time do you have to keep up with developments outside your own specialism, and how do you ensure the standards you are working to conform to best practice? Access to an external advice and update service will often be easier and less costly.

Amalgam toxicity

The debate over chronic toxicity of mercury dental amalgam may have some distance to go. With the increasing availability of social media, just two or three vociferous campaigners can make (and have made) a huge impact on the public perception – and it seems the calls for removal of dental amalgam will not go away any time soon. However, regardless of any potential impact on health, what is your policy on waste segregation and management?

Th e Landfi ll Directive introduced in July 2004 made it almost impossible to legally dump mercury or mercury contaminated products in the UK, resulting in a massive growth in recycling and consultancy services. How accurately do you measure your inventory – and how confident are you that you are fully compliant with your waste management obligations?

Clinical sharps

It seems redundant to emphasise that sharp blades and needles can cut or puncture staff as easily as they cut and puncture patients undergoing treatment. Yet sharps injuries do still occur, with all the consequential risks. Last year the UK introduced laws specifically requiring health workers to manage the risk. Do you know your obligations under the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013? Have you reviewed your policies and practices to ensure that collection bins are never overfilled? And who handles these from first opening to final collection? Do you need to do anything more to prevent reduce or manage the risks of accidental inoculation or laceration?

Trivial hazards, serious incidents

Thankfully, for most practices, these risks will never be realised. No one will be injured, there will be no catastrophic fires and everyone will assume the place is safe. Unfortunately, the absence of consequence does not mean the absence of risk. If any workplace simply assumes it is safe because no one has yet fallen victim to an unidentified risk then it can only be a matter of time before the luck runs out. Even apparently trivial hazards can cause serious incidents.

A specialist health and safety service, such as the one available at Law at Work, can assist in the identification and management of a whole range of issues. Dentistry does not need to be high risk, but sometimes things go wrong and it can be reassuring to know you have done all you can to prevent harm.

Steve Ashton is head of health and safety services at Law at Work

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