Occuptional Hazard
Occuptional Hazard
Occuptional Hazard
Handbook of Occupational
Hazards and Controls for
Dental Workers
Credits
This document has been developed by the Government of Alberta and derived as a profession-specific summary of information
contained in the five volumes of Best Practices in Occupational Health and Safety in the Health Care Industry. Full text of these
documents can be found at http://www.employment.alberta.ca/SFW/6311.html
Disclaimer
Information in this document is provided solely for the users information and is provided strictly on an as is basis and without any
warranty of any kind. The Crown, its agents, employees or contractors will not be liable for any damages, direct or indirect, or lost
profits arising out of use of information provided in this document or for information provided at any of the resource sites listed in this
document.
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Table of Contents
Introduction ........................................................................................................................................................................... 3
Hazard Assessment Process ................................................................................................................................................ 4
Potential Hazards and Recommended Controls ................................................................................................................... 4
Biological Hazards and Controls ........................................................................................................................................ 5
Notes about controls for biological hazards ................................................................................................................... 6
Chemical Hazards and Controls ...................................................................................................................................... 16
Notes about controls for chemical hazards .................................................................................................................. 24
Physical Hazards and Controls ........................................................................................................................................ 31
Notes about controls for physical hazards ................................................................................................................... 34
Psychological Hazards and Controls ............................................................................................................................... 42
Selected notes about controls for psychological hazards ............................................................................................. 46
APPENDIX 1 - OHS-related Competencies for dental personnel ........................................................................................ 51
APPENDIX 2 - Additional Resources .................................................................................................................................. 53
APPENDIX 3 - Learning Objectives for this Module ............................................................................................................ 56
APPENDIX 4 - Test Your Knowledge .................................................................................................................................. 57
INDEX ................................................................................................................................................................................. 60
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Occupational Health and Safety Hazards and Controls for Dental Workers
Introduction
As part of the Alberta Healthcare Initiative, a series of Best Practice documents were produced by Alberta Employment and
Immigration Workplace Health and Safety to better acquaint healthcare workers with workplace hazards and appropriate control
measures. Five documents have been produced; each developed with the input of a multidisciplinary stakeholder group. The
documents are available on the Alberta Employment and Immigration website http://www.employment.alberta.ca/SFW/6311.html as
follows:
Overview of Best Practices in Occupational Health and Safety in the Healthcare Industry Vol. 1
http://www.employment.alberta.ca/documents/WHS/WHS-PUB_bp009.pdf
Best Practices for the Assessments and Control of Biological Hazards Vol. 2
http://www.employment.alberta.ca/documents/WHS/WHS-PUB_bp010.pdf
Best Practices for the Assessments and Control of Chemical Hazards, Vol. 3
http://www.employment.alberta.ca/documents/WHS/WHS-PUB_bp011.pdf
Best Practices for the Assessments and Control of Physical Hazards, Vol. 4
Best Practices for the Assessments and Control of Psychological Hazards, Vol. 5
In an effort to focus the hazard assessment and control information for specific healthcare professions, a series of short summaries
of relevant information have been produced using excerpts from the five best practice documents. Readers are directed to the
original documents for more details and more comprehensive information. Please note that hyperlinks are provided to reference
documents for the convenience of the reader. These links are functional at the time of first availability of this document but, due to
the changing nature of web information, may not be functional at a later date. The Government of Alberta does not assume
responsibility for updating hyperlinks.
This document focuses on hazards and controls in dental offices and clinics.
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Equipment to minimize
formation of aerosols (rubber
dams, high-speed evacuation,
etc.). Obtain medical history of
patients. Engineered needle
stick prevention devices.
Availability of sharps
containers for disposal. Proper
disinfection of instruments and
decontamination of
environmental surfaces, lab
supplies and materials.
Vaccines.
Medical history of patients.
Vaccines.
PPE
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education.
Maintenance of ventilation
systems. Early spill clean-up.
Preventive maintenance of
ventilation systems and water
supply systems with regular
testing to ensure proper
functioning. Early detection
and remediation of mould.
possible. Gowns or
uniforms that should be
changed daily or when
contaminated.
PPE based on the risk
assessment may include
gloves, respiratory
protection, eye protection
and other protective
clothing.
Use of proper PPE when
cleaning contaminated
environmental surfaces,
including gloves,
respiratory protection,
and eye protection.
Engineering Controls
In the hierarchy of controls, the highest level of control is directed at the source. From an occupational health perspective, the
highest level of control may be immunization of workers who may come in direct contact with infected patients. Good engineering
controls such as proper design and maintenance of facilities, room design, the use of needleless systems and engineered needle
stick prevention devices, and effective biological waste containment also contribute to minimizing the transmission of infectious
agents. Engineering controls, once designed and implemented, are not under the control of the worker, but are directed at the
source of the hazard.
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This section was modified from Laboratory Safety: CSMLS Guidelines, sixth edition; Gene Shematek & Wayne Wood; Canadian Society for
Medical Laboratory Science; 2006.
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General ventilation
General ventilation systems serving buildings must be maintained regularly and inspected for conditions that could adversely affect
air quality provided to work spaces. Accumulations of water that could stagnate in humidification systems or drip trays may become
sources of potential biological contamination of air handling systems that need regular monitoring and inspection.
Biohazardous organisms may be carried through general ventilation systems, potentially distributing them to other workspaces in a
facility. Ultraviolet germicidal irradiation units, and or HEPA filtration media incorporated into air handling systems may be warranted
for special circumstances.
Mould growth in the indoor environment can be affected by relative humidity levels, which is a function of some general ventilation
systems. High relative humidity levels may contribute to an increase in the growth of some moulds and lead to condensation
developing on surfaces. Control of indoor relative humidity levels is an important factor in preventing mould growth.
Administrative Controls
The next level of controls includes administrative controls. Because it is not always possible to eliminate or control the hazard at the
source, administrative controls are frequently used for biological hazards in healthcare. Administrative controls focus on ensuring
that the appropriate prevention steps are taken, that all proper work procedures are documented, that dental personnel are trained to
use the proper procedures, and that their use is enforced. Administrative controls include policies and procedures that establish
expectations of performance, codes of practice, staff placement, required orientation and training, work schedules, and occupational
health programs in which baseline immune status is recorded and immunizations are provided.
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A comprehensive management system considers the continuum of infection prevention and control efforts across all sites and
operations. It includes attention to patient as well as worker safety. A comprehensive system should include the following
components:
A process that ensures comprehensive hazard assessments are conducted for all sites and tasks and appropriate controls are
identified
An infection prevention and control plan with clear designation of roles and responsibilities
Consistent standards for the cleaning, disinfection and sterilization of equipment, procedures, and policies including Routine
Practices, Additional Precautions, hand hygiene policies and facilities, patient risk assessments, communication protocols,
decontamination of equipment and clothing and dedicated clothing
Hands free or no touch techniques for the passing of instruments
Outbreak prevention and management
Required orientation and ongoing education
Biomedical waste handling procedures and policies
Supporting systems that include
Adequate housekeeping and waste management services
Appropriate processes for cleaning, decontamination, disinfection and sterilization of patient care equipment
Purchasing processes to include consideration of safety factors
A comprehensive surveillance and monitoring plan
Record keeping and regular reporting of outcomes
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Surfaces must be decontaminated after any spill of potentially infectious materials. Specific written protocols must be developed and
followed for each decontamination process. Dental personnel must be trained in all decontamination procedures specific to their
activities and should know the factors influencing the effectiveness of the treatment procedure.
Chemical Disinfectants
Chemical disinfectants are used to decontaminate surfaces, reservoirs of infectious material, and to clean up spills of infectious
material. The choice of chemical disinfectant must be made carefully based on:
Types of organisms, suspected or known
Items or surfaces to be decontaminated
Hazards posed to the worker by the disinfectant
Cost of disinfectant
Corrosiveness of disinfectant
Shelf life and required dilution of disinfectant
Material which inactivates the disinfectant
In many cases, the choice of disinfectant for specific uses may be standardized in the organization and made after evaluation by IPC
and OHS professionals.
Considerations in the use of chemical disinfectants
Choose the disinfectant carefully. More than one may be required. Keep in mind the items to be disinfected, and the properties
and limitations of the various available disinfectants. If more than one disinfectant is required, ensure that those selected are
chemically compatible.
Follow the manufacturer's directions for making the proper dilutions of the disinfectants.
The effective life of disinfectants can vary depending on the formulations and the conditions of usage. Follow the manufacturers
directions.
The effective exposure time that the disinfectant must be in contact with the contaminant will also vary with conditions of usage.
Often overnight exposure may be recommended to ensure effective decontamination.
Understand the health and safety hazards that may be posed by a particular disinfectant and ensure appropriate precautions are
taken. Wear disposable gloves when using any disinfectants. Wear other personal protective equipment or clothing as
necessary, depending upon the disinfectants. Consult Material Safety Data Sheets for details.
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Workers with particular sensitivities to specific disinfectants should avoid using those disinfectants.
Perform tests of the disinfectants to ensure effective disinfection.
Training
Training in biological hazards and controls should be provided to all dental workers. Each dental worker must understand the
employers IPC and OHS programs as they relate to his or her job duties. For newly hired dental workers, all relevant IPC and OHS
policies and procedures must be provided before they start work. To ensure that dental workers understand and apply this
information to their jobs, specific training should also be provided to address job-specific biological hazards. Periodic refresher
training to reinforce policies and procedures and introduce any new practices will benefit all dental workers. Competency
assessments should be provided for all training, and training records should be maintained.
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Ideally, the immunization and surveillance programs should provide easy, authorized access to dental worker immune status records
for follow up of exposure incidents and outbreaks. In some cases, immunizations or baseline testing may be required prior to
commencement of work.
Gloves
Gloves are the most common type of PPE used for dental tasks. Gloves are made from a variety of materials including latex, nitrile,
neoprene, copolymer, and polyethylene and are available in various levels of thickness. When dealing with infectious materials,
gloves must be waterproof. Most patient care activities require non-sterile gloves, whereas any invasive procedure should be
performed using sterile surgical gloves. Latex gloves should be avoided due to the risk of latex allergy unless there is a
demonstrated safety requirement for latex to be used. The Canadian General Standards Board (CGSB) certifies medical gloves,
which is a key factor in selecting gloves for use in healthcare. The choice of gloves must often balance the needs for protection and
dexterity. While thicker gloves (or double gloves) may appear to provide greater protection, it may make tasks more difficult and
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increase the exposure risk. In Recommendations for Canadian Health Care and Public Service Settings2, it is noted that the
Selection of the best glove for a given task should be based on a risk analysis of the type of setting, type of procedure, likelihood of
exposure to blood or fluid capable of transmitting bloodborne pathogens, length of use, amount of stress on the glove, presence of
latex allergy, fit, comfort, cost, length of cuffs, thickness, flexibility, and elasticity.
Safe Practices for Glove Use3
Wear medical gloves when there is a risk of contact with blood, body fluids or substances, mucous membranes, open wounds or
skin lesions.
Wear gloves that are certified by the CGSB.
Wear gloves when handling items contaminated with blood, body fluids, secretions or excretions.
Wear gloves if you have any cuts or lesions on your hands or if you have dermatitis affecting your hands.
Avoid latex gloves and powdered gloves to reduce sensitization or allergic reactions.
Ensure that the gloves fit properly.
Inspect gloves for holes or tears, discarding any damaged gloves.
Put gloves on just before beginning the task, and remove them promptly when finished and before touching any environmental
surfaces.
Work from clean to dirty (touching clean sites or surfaces before dirty or contaminated ones).
Do not touch your face or adjust PPE with contaminated gloves and avoid touching uncontaminated items such as light switches,
telephones, etc. while wearing gloves.
Change gloves when they become soiled, during lengthy procedures, and between patients.
Remove gloves carefully according to the IPC guidelines and dispose of them properly.
Wash hands before using and after removing gloves.
Never reuse or wash single-use disposable gloves.
Recommendations for Canadian Health Care and Public Service Settings; found at http://www.phac-aspc.gc.ca/publicat/ccdrrmtc/97vol23/23s3/index.html
3
Modified from information provided in Preventing the Transmission of Blood Borne Pathogens in Health Care and Public Service Settings. Found
at http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/97vol23/23s3/index.html (See Supplement)
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PPE is required when there is the potential for exposure of the face to splashes or sprays of infectious material. The selection of
eyewear depends upon the tasks being conducted. Types of eye protection include safety glasses, goggles, visors, face shields and
table mounted barrier shields. Regular prescription eyewear and contact lenses are not considered effective as PPE. Safety
eyewear should fit the wearer, be clean and well maintained and stored. If necessary, goggles may be fitted with prescription lenses
or worn over glasses. Face shields should cover the forehead, extend below the chin, and wrap around the side of the face. Masks
protect the mucous membranes of the nose and mouth from exposure to large droplets that may contain infectious materials. Masks
are commonly used to contain droplets at the source (for example, the dental worker or patient with a cough). Masks should fully
cover the nose and mouth and fit snugly. Masks worn by patients reduce exposure through droplet containment at the source, and
respirators worn by health care workers reduce exposure to the respiratory system.
The Difference between a Surgical or Procedure Mask and a Respirator
Surgical or Procedural Masks
Surgical Masks are not designed to seal tightly against the dental
workers face or certified to prevent inhalation of small
droplets/particles.
When the dental worker inhales, contaminated small droplets can pass
through gaps between the face and surgical mask.
Surgical masks provide a physical barrier for protection from splashes
of large droplets of blood or body fluids.
Surgical masks are used for several purposes including:
o Prevention of accidental contamination of patients wounds with
pathogens normally present in mucus or saliva
o Placed on sick patients to limit spread of infectious respiratory
secretions to others
o Protection from splashes or sprays of blood or body fluid
o Assist to keep dental workers contaminated hands from
contacting their own mucous membranes
*Adapted from OSHA (2007) Guidelines on Preparing Workplaces for an Influenza Pandemic
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Controls
These are examples of chemicals, uses, health effects and controls. For each chemical used in the workplace, specific information MUST be
consulted to determine controls based on what the product is used for, how it is used and the environment it is used in. This may be found on
MSDSs, information provided by the manufacturer or supplier, or other sources. Individual reactions to chemicals must also be considered in
determining appropriate controls.
Alcohol hand
sanitizers
Hand hygiene
when water is
not available
and hands are
not visibly soiled
http://www.ottawa.ca/residents/healt
h/emergencies/pandemic/hand/faq_
gel_en.html
http://employment.alberta.ca/docum
ents/WHS/WHS-PUB_fex002.pdf
http://www.municipalaffairs.alberta.c
a/documents/ss/STANDATA/fire/fcb
/97fcb026.pdf
Detergents
Low Level
Disinfectants
Cleaning a
variety of
surfaces
Chlorine
compounds,
alcohols,
quaternary
ammonium
salts, iodophors,
phenolic
http://www.hercenter.org/hazmat/cle
aningchems.cfm
http://www.museo.unimo.it/ov/fdrEd
ete.htm
http://ehs.virginia.edu/biosafety/bio.
disinfection.html
http://www.cdc.gov/niosh/topics/che
mical.html
http://cms.h2e-
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Glutaraldehyde
Hydrogen
Peroxide
compounds,
hydrogen
peroxide used
widely for
disinfection;
usually prepared
and used in low
concentrations.
High level
disinfection of
medical devices.
May also be
used in tissue
processing
Sterilization of
medical devices
and surfaces
online.org/ee/hazmat/hazmatconcer
n/steril/
http://www.osha.gov/Publications/32
58-08N-2006-English.html
http://www.mtpinnacle.com/pdfs/disi
nfectant-selection-guidelines.pdf
http://www.osha.gov/SLTC/etools/h
ospital/hazards/glutaraldehyde/glut.
html
http://www.cdc.gov/niosh/docs/2001
-115/
http://www.sustainablehospitals.org/
cgi-bin/DB_Index.cgi.
http://www.cdc.gov/niosh/npg/npgd0
335.html
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Orthophthalaldehyde
(OPA)
High level
disinfection of
medical devices.
Replaces
glutaraldehyde
containing
disinfectants.
Controls
http://www.mtpinnacle.com/pdfs/Cy
dex.pdf
http://www.aspjj.com/us/supports/m
aterial-safety-data-sheets
http://www.sustainablehospitals.org/
cgi-bin/DB_Index.cgi
These are examples of chemicals, uses, health effects and controls. For each chemical used in the workplace, specific information MUST be
consulted to determine controls based on what the product is used for, how it is used and the environment it is used in. This may be found on
MSDSs, information provided by the manufacturer or supplier, or other sources. Individual reactions to chemicals must also be considered in
determining appropriate controls.
Anaesthetic
4
gases
Used to induce
anaesthesia by
inhalation in
operating
Exposure is primarily
through inhalation.
Neurological and
reproductive effects.
http://www.ccohs.ca/oshanswers/ch
emicals/waste_anesthetic.html
4 23
,
Information from linked sources plus Essential of Modern Hospital Safety, Volume 3, William Charney, ed. 1994, CRC Press, ISBN 1-56670083-3.
19 | P a g e
theatres and
dental offices;
may off-gas in
recovery rooms
and ICUs
Exposure and
Health Effects
Information
Controls
These are examples of chemicals, uses, health effects and controls. For each chemical used in the workplace, specific information MUST be
consulted to determine controls based on what the product is used for, how it is used and the environment it is used in. This may be found on
MSDSs, information provided by the manufacturer or supplier, or other sources. Individual reactions to chemicals must also be considered in
determining appropriate controls.
Compressed
gases
Latex
Commonly
used for patient
treatment i.e.
oxygen, nitrous
oxide. Also
commonly used
in maintenance
activities.
Liquid nitrogen
is used for
tissue
preservation
and cryotreatment (e.g.
wart removal)
Used in gloves,
medical
Asphyxiation,
anaesthetic effects.
Toxicity is dependant
on chemical products.
Other hazards include
explosions, fire
hazards, flying
projectiles, and release
of gas. Cryogenic
gases may also cause
skin damage through
freezing.
http://www.ccohs.ca/oshanswers/ch
emicals/compressed/compress.html
http://www.worksafebc.com/publicat
ions/health_and_safety/by_topic/as
http://www.ccohs.ca/oshanswers/pr
evention/comp_gas.html
http://www.chem.ubc.ca/safety/safet
y_manual/hazard_chem_gases.sht
ml
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Mercury
Methyl
methacrylate
devices, some
respirators,
elastic bands,
balloons, etc.
dermatitis, allergic
contact dermatitis, and
allergic responses
including immediate
hypersensitivity and
shock.
Metallic
mercury may be
found in
thermometers,
pressure
gauges
(manometers),
other medical
devices and
dental fillings,
etc.
Exposure is through
inhalation of vapours,
ingestion and skin
absorption. Skin
sensitizer. Corrosive as
liquid. Target effects to
the nervous system,
kidneys, cardiovascular
and eyes.
Surgical and
dental
prosthesis
ventilation systems.
A- Purchasing controls to limit latex
containing materials from entering
facility. Safe work procedures.
Education of workers in the nature of the
hazard, hand washing after glove
removal, proper glove donning and
removal. Work reassignment for workers
with latex allergies to areas where latex
is not present. As per hazard
assessment.
E- Elimination of mercury containing
equipment. Substitution with less
harmful product. Enclosed mercury
sources. Mechanical amalgamators to
ensure no physical contact. Properly
designed and maintained ventilation
systems. Local exhaust ventilation may
be required.
A- Safe work procedures including spill
procedures. Education of workers in the
nature of the hazard. Purchasing
controls to restrict mercury containing
materials from entering facility.
Monitoring of the work environment
following a spill. Good hygiene
practices. Appropriate storage of
products to decrease exposure.
P- Protective clothing, gloves, eye and
face protection, and respiratory
protection based on hazard assessment.
E- Substitution with less harmful product.
Properly designed and maintained
ventilation systems. Enclosed mixing
devices. Local exhaust ventilation.
A- Safe work procedures. Good hygiene
practices. Education of workers in the
nature of the hazard. WHMIS program
and maintenance of MSDSs. Medical
monitoring of workers.
sets/pdf/latex_allergies.pdf
http://www.ccohs.ca/oshanswers/dis
eases/latex.html?print
http://employment.alberta.ca/docum
ents/WHS/WHS-PUB_ch003.pdf
http://www.cdc.gov/niosh/npg/npgd0
383.html
http://www.mtpinnacle.com/pdfs/ME
RCURY-USE-%20HOSPITALSAND-CLINICS.pdf
http://www.cdc.gov/niosh/npg/npgd0
426.html
http://www.cdc.gov/niosh/hcwold5b.
html
http://www.cdc.gov/niosh/npg/npgd0
426.html
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Various metals
(e.g. beryllium,
chromium,
cobalt and
nickel)
Used for
castings of
bridge
framework
Silica
Mixing
porcelain
powders;
grinding or
polishing dried
porcelain;
investment and
divestment of
castings
Personal care
products, scents
and fragrances
A wide range of
products
including
personal care
items such as
shampoos,
soaps,
perfumes,
creams,
deodorants, etc.
Also contained
in, cleaning
products.
http://www.cdc.gov/niosh/npg/npgd0
426.html
http://www.cdc.gov/niosh/hcwold5b.
html
http://www.cdc.gov/niosh/npg/npgd0
426.html
http://www.mdamyanmar.org/journals/MyanmarDental-Journal-2008.pdf
http://www.ccohs.ca/oshanswers/hs
programs/scent_free.html
22 | P a g e
In this section the chemical exposure hazards most commonly encountered by dental personnel and methods to control them are
presented. Employers should carefully evaluate the potential for exposure to chemical hazards in all dental tasks and ensure that
they have an effective hazard control plan in place. This information will be useful for inclusion into hazard assessments. Please
note, this is not designed to be an exhaustive treatment of the subject, but is rather an overview summarizing the most frequently
encountered chemical hazards encountered by dental personnel.
Note:
The following charts taken from Volume 3 Best Practices for the Assessment and Control of Chemical Hazards in Healthcare
provide basic information about control strategies for commonly occurring chemical hazards related to dental tasks. The selection of
controls must be based on a risk assessment of the tasks and environment. Worker education and good communication processes
are critical administrative controls. All legislation related to the assessment of hazards, selection and use of controls must be
followed
Potential Chemical Hazards
PPE
Elimination of mercury
containing amalgams.
Substitution with less harmful
product. Maintain adequate
general ventilation. Local
exhaust ventilation when
removing old amalgams.
Protective clothing,
gloves, eye and eye
protection, and
respiratory protection.
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Elimination of scented
products. Substitution with
less harmful products.
Maintain adequate general
ventilation.
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For dental personnel, chemical exposures may be limited by ensuring the facilities well designed, have effective ventilation, have
automated equipment that reduces manual handling of chemicals, adequate storage for any chemicals used and have easily
cleanable surfaces.
Elimination
Elimination of a hazardous chemical from the dental workplace is always desirable but not always possible. For example, working
with chemicals is required when working with amalgams and other dental prostheses, anaesthetic gases must be used for surgeries,
disinfectants are required when biological hazards are present, cleaning solutions are necessary to maintain hygienic conditions, and
reagents are required for dental materials.
Substitution
Some chemicals used in the dental environment are chosen based on tradition or cost. In recent years, efforts have been made to
find less hazardous alternatives to some of the chemicals commonly used. When substituting a chemical for one that is currently in
use, it is critical to ensure that the new chemical does not have properties that may make it more toxic or more flammable, etc.
Some examples of substitution of chemical hazards in healthcare:
Replacing mercury-containing devices (manometers, thermometers) with non-mercury containing alternatives.
Using dental alloys that do not contain beryllium
Using accelerated hydrogen peroxide-based disinfectants instead of glutaraldehyde.
Using hydrogen peroxide-based cleaners rather than chlorine- based cleaners.
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Administrative Controls
Policies and procedures, training
As administrative controls, policies and procedures should be in place to ensure that there are safe work procedures for storing and
using chemicals and discarding chemical wastes appropriately. Dental workers may come into contact with a number of chemicals
through exposure to chemicals that may be present in dental materials and disinfection procedures. Workplace Hazardous Materials
Information System (WHMIS) training should be provided to all dental personnel. In addition, emergency call lines that provide
expertise and advice regarding toxic chemicals should be made available.
WHMIS Program
A WHMIS program is an administrative control to reduce the risk of exposure to chemicals in the workplace and is a legal
requirement for all employers who use controlled products in Alberta. To be effective, a WHMIS program must be relevant to the
workplace, presenting information and training specific to the chemicals that are used in the workplace. The components of WHMIS
include having current Material Safety Data Sheets for all products in the workplace, ensuring all products are appropriately labelled
and ensuring that all workers are instructed on how to use the chemicals safely.
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workers who are exposed to certain chemicals in the workplace. In some cases, dental employers establish medical surveillance
programs to monitor potential exposures to hazardous materials.
Gloves
The most frequently used PPE by dental workers to prevent exposure to chemicals is gloves. When choosing gloves, the following
must be considered:
The nature and concentration of the chemicals
The amount of time the gloves will be exposed to the chemical
Dexterity required to perform the task
Extent of protection needed (to wrist or higher)
Decontamination and disposal requirements
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Respirators
According to the Alberta Occupational Health and Safety Code 20097, there is a duty to provide and use respiratory protective
equipment (RPE) when a hazard assessment indicates that a worker may be exposed to airborne contaminants or exposed to an
oxygen deficient environment. Employers are required to use engineering and administrative controls before using RPE (respecting
the hierarchy of controls). Respirators may be required to protect dental workers from exposure to chemicals by inhalation.
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Protective Clothing
Chemical protective clothing is available as gowns, aprons, uniforms, coveralls, and foot covers. The choice of protective clothing
relies on an accurate hazard assessment. Should protective clothing become contaminated with a chemical or damaged, the
clothing must be removed and handled according to organizational procedures (disposal or proper decontamination). Residual
chemicals such as acids on clothing may continue to present an exposure hazard. Workers must not wear clothing that is
contaminated with chemicals home, as this may pose a danger to themselves and others.
Worker Decontamination
If a worker is contaminated by a harmful substance at the worksite, the employer must ensure that only those items that have been
properly decontaminated or cleaned are taken from the worksite
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PPE
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Ergonomically designed
workstation, chairs,
instruments and equipment.
Use automatic and ultrasonic
instruments and tools
whenever possible. Use of
indirect vision when treating
maxillary teeth. Consider a
non-traditional stool such as a
saddle chair (improve posture
and mobility). Minimize glare
through the use of appropriate
lighting and window coverings.
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program.
Worker education. Safe work
procedures including review and
attention to equipment
manufacturers guidelines.
Perform regular maintenance on
flooring, stairwells, hallways,
handrails, etc. Inspect ladders
prior to use. Worker education.
Implement a spill cleanup program
that includes prompt spill cleanup,
use of warning signs, etc. Maintain
good housekeeping practices and
minimize clutter and tripping
hazards.
Worker education. Safe work
procedures.
Gloves
Heat-resistant gloves.
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dropped or mishandled
Radiation
Shielding is a critical engineering control for controlling exposure to external ionizing radiation hazards. It relies on providing a
specific barrier material that absorbs, stops or attenuates the radiation. The use of shielding requires a careful consideration of the
type of radiation, the required thickness of the shielding material, the location of the workers, and the potential for leakage or scatter.
Other engineering controls include design considerations, interlock systems and equipment selection and maintenance. For both
ionizing and non-ionizing radiation, design considerations are important as engineering controls to prevent exposures. For ionizing
radiation, permanent shielding should be provided in areas where there is frequent need for shielding. Mazes and other traffic area
34 | P a g e
designs are used to reduce exposure by providing barriers and reducing traffic. The placement of equipment can greatly reduce
awkward movement for workers.
For lasers, engineering controls include ensuring the area has no reflective surfaces, the provision of fail-safe system and lock/key
access for activation as well as interlock systems
Interlock systems are mechanical systems that prevent the operation of the equipment or some facet of the equipment until an action
or other system is engaged or completed. Interlock systems are used extensively in radiation equipment to ensure that the
equipment cannot be accidentally activated.
The choice and the maintenance of equipment are critical engineering controls. Equipment design that includes advanced safety
features (such as audible/visible signals when the equipment is operating, interlock or key/lock systems, permanent shielding, etc.)
should be considered whenever possible. Equipment calibration and maintenance will ensure the equipment performs optimally and
reduces the potential for accidental worker exposure.
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Cuts
The most effective controls to reduce cuts are engineering controls. Common engineering controls include
Substitution of medical sharps with safety engineered medical devices (SEMDs)
Substitution of a sharp instrument with a less sharp alternative (e.g. engineered sharps injury prevention devices)
Safety cutters as bag and box openers
Proper storage and disposal of sharps
Transfer trays and magnetic drapes in during dental surgery
Temperature Extremes
Cryogenic liquids are liquefied gases that are maintained in a liquid state by keeping them at very low temperatures and maintaining
them under pressure. Major hazards associated with cryogenic agents are the rapid expansion of the gases resulting in increased
concentration of the gas in surrounding air, and burns from contact with the cryogenic agent or material or equipment that contains it.
The increased concentration of gases may cause asphyxiation if the gases displace oxygen or the gases themselves may be toxic.
In addition, under some circumstances, cryogenic agents can be flammable or can be explosive when expanding rapidly.
Exposure of tissues to cryogenic materials or frozen surfaces can cause severe burns (frostbite) or cause tissue to become stuck to
metal that is cooled by cryogenic agents.
Substitution with a less hazardous freezing agent would be the engineering control of choice if possible. Other engineering controls
include local exhaust ventilation where cryogens are stored and used (the type depending upon the hazard assessment), effective
general ventilation to dilute any vapours, design of storage area to ensure proper segregation of chemicals, use of proper and wellmaintained storage vessels, restricted access to storage areas, proper calibration and maintenance of equipment, pressure release
valves, and alarm systems.
Heat-related burns may occur during flash sterilization or through contact with hot surfaces, fire, or steam. Engineering controls are
aimed at reducing contact with hot surfaces or steam. These include effective workplace design (that limits traffic in hot areas,
reduces proximity to hot surfaces, provides sufficient space to work and move around hot equipment, etc.), shielding, process
changes, local exhaust ventilation for the removal of steam, interlock systems that prevent opening autoclaves or sterilizers until a
cooler temperature is reached, mechanical devices (tongs, etc.) for manipulating hot items, temperature and pressure relief valves,
and reducing hot water temperatures.
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Pressure
Compressed gas cylinders are designed to safely hold their contents during regular use and the demands expected to be placed on
them. Regulators, fittings and delivery systems must likewise meet manufacturers requirements. Cylinders should be stored away
from any heat sources or combustible material; they should be stored upright and not be able to move freely or fall.
Protective valve caps are an engineering control to protect the valve head from damage when the cylinder is not in use. If the
cylinder has a valve cap, the cap should always be placed on cylinders when the cylinder is not expected to be used for a period of
time, such as for a work shift. All cylinders must be restrained from tipping by means of racks, chains, strap or other suitable means.
Electrical Hazards
Insulation protects workers from contact with electricity. All equipment, wiring and cords must be maintained and used in a manner
that keeps electrical insulation intact.
Electric appliances and equipment are protected from overloading by means of electric overloading devices such as fuses or circuit
breakers. Although these devices will stop the flow of current when too much current flows through them, they are intended to
protect equipment but not workers. All overloading devices must be of sufficient ratings. Replacing fuses or circuit breakers with
overloading devices that trip at a higher current than specified is a dangerous practice as is replacing overloading devices with a
conductor. Ground fault circuit interrupters (GFCIs) are safety devices that will interrupt the flow of current by monitoring the flow of
current to and from the device. GFCIs are important engineering controls that should be used in wet environments and to power
tools and equipment outdoors.
Another important engineering control is grounding. Grounding of electrical equipment refers to creating an electrical path to earth
(ground). Grounding provides some protection to equipment operators if there is a fault in the equipment or insulation that energizes
the equipment housing; electricity would flow to ground rather than through the worker. Grounding for equipment that is plugged into
electrical receptacles can be identified by the third prong on the electrical plug. Similarly electrical cords commonly have a third
prong on the plug end. The third prong that facilitates grounding must not be removed or defeated. The housings of all equipment
should be suitably grounded. Some electrical cords for tools or other equipment do not have a third grounding prong. This
equipment is double insulated, meaning that it has been designed with additional insulating considerations to prevent the housing of
the device from becoming energized. Such a device will be labelled with the term double insulated or with a symbol comprised of a
square box within another square box.
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Administrative Controls
Ergonomic hazards
Controls that focus on how work is performed and organized are administrative controls. Administrative controls include policies,
procedures, work practices, rules, training, and work scheduling, including:
Establish ergonomic purchasing standards for tools and equipment.
Conduct user trials to test new equipment and tools with input from workers.
Maintain equipment and tools to optimize their operation.
Provide training programs to educate workers regarding biomechanical risk factors, signs and symptoms and safe work practices,
(including proper lifting methods and proper use of lifting devices).
Provide self assessment tools to identify and control biomechanical hazards.
Design break schedules to reduce biomechanical hazards.
Encourage monitoring and early reporting of the signs and symptoms of MSIs.
Radiation
Administrative controls include policies and procedures and on-going assessment of possible exposures to radiation. The policies
and procedures are designed to ensure that workers are informed about the hazards of both ionizing and non-ionizing radiation and
are trained in the safe work procedures necessary to prevent exposure. Some administrative controls include having a radiation
safety program, a laser safety program, safe work practices, monitoring exposures, and proper disposal practices. Minimize contact
with body substances from patients receiving treatment with radionuclides.
Cuts
Administrative controls widely used to reduce the potential for cuts include
Educating workers
Following safe work procedures (including no-touch instrument passing)
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Temperature Extremes
For cryogenic hazards, administrative controls include worker education about the nature of the hazard and how to work safely with
cryogenic agents, safe work practices (including insertion of materials so that boiling and splashing can be avoided, avoiding
touching the skin with any part of the equipment, purchasing appropriate vials for freezing and thawing, etc.), and emergency
response procedures for spills or exposures. To reduce the risk of burns, administrative controls include worker education,
established safe work practices, assessment of work area to identify potential sources of burns, and equipment maintenance
programs.
Pressure
Compressed gas cylinders must be handled, maintained and stored carefully to prevent cylinders from falling or a gas release.
Proper transportation of cylinders must also be considered whether it be by vehicle or within a work area by use of a hand cart or
other means. A safe work procedure should be developed for the use, transport, storage and maintenance of compressed gas
cylinders in the workplace. Some key compressed gas safe work practices are detailed below:
What are basic safe practices when working with compressed gases?8
Read the MSDSs and labels for all of the materials you work with.
Know all of the hazards (fire/explosion, health, chemical reactivity, corrosivity, pressure) of the materials you work with.
Know which of the materials you work with are compressed gases and check the label, not the cylinder colour, to identify the gas.
Store compressed gas cylinders in cool, dry, well-ventilated areas, away from incompatible materials and ignition sources.
Ensure that the storage temperature does not exceed 52oC (125oF).
CCOHS; OSH Answers How Do I Work Safely with Compressed Gasses?; July 8, 2008;
http://www.ccohs.ca/oshanswers/prevention/comp_gas.html
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Store, handle and use compressed gas cylinders securely fastened in place in the upright position. Never roll, drag, or drop
cylinders or permit them to strike each other.
Move cylinders in handcarts or other devices designed for moving cylinders.
Leave the cylinder valve protection cap in place until the cylinder is secured and ready for use.
Discharge compressed gases safely using devices, such as pressure regulators, approved for the particular gas.
Never force connections or use homemade adaptors.
Ensure that equipment is compatible with cylinder pressure and contents.
Carefully check all cylinder-to-equipment connections before use and periodically during use, to be sure they are tight, clean, in
good condition and not leaking.
Carefully open all valves, slowly, pointed away from you and others, using the proper tools.
Close all valves when cylinders are not in use.
Never tamper with safety devices in cylinders, valves or equipment.
Do not allow flames to contact cylinders and do not strike an electric arc on cylinders.
Always use cylinders in cool well-ventilated areas.
Handle "empty" cylinders safely: leave a slight positive pressure in them, close cylinder valves, disassemble equipment properly,
replace cylinder valve protection caps, mark cylinders "empty" and store them separately from full cylinders.
Wear the proper personal protective equipment for each of the jobs you do.
Know how to handle emergencies such as fires, leaks or personal injury.
Follow the health and safety rules that apply to your job.
Electrical Hazards
A major component of an electrical safety program is worker training. Extension cords are used in many applications for temporarily
supplying power. Considerations to follow when using extension cords include:
Protect cords from damage; do not allow vehicles to drive over cords.
Never keep an extension cord plugged in when it is not in use.
Do not use a damaged extension cord.
Extension cords and most appliances have polarized plugs (one blade wider than the other). These plugs are designed to
prevent electric shock by properly aligning circuit conductors. Never file or cut the plug blades or grounding pin of an extension
cord.
Do not plug one extension cord into another. Use a single cord of sufficient length.
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Hazard assessments should guide the development of work procedures to assess and control electrical hazards.
Radiation
Depending upon the nature of the radiation and the specific tasks the worker is performing, a range of PPE may be used as
additional controls (to engineering and administrative controls) to reduce exposures. Examples include protective eyewear used
when working with lasers, UV, infrared or ionizing radiation that is specifically made to reduce exposure to each type of radiation.
Protective clothing is also used when working with various forms of radiation. For ionizing radiation, protective clothing (commonly
called lead aprons) includes shielding materials. All ionizing radiation protective clothing must be uniquely identified and inspected
annually with an x-ray machine for any cracks or holes in the shielding material. These inspections results must be recorded and
saved. Clothing also protects against exposure to UV rays. Gloves protect workers from contamination with radioactive material and
must be worn when there is the potential for contamination.
Cuts
Eye protection is important if there is any possibility that fragments of glass or other sharps may enter the eyes, and footwear must
protect the wearer from accidental exposure to sharps. Gloves are usually required as PPE to protect workers from cuts. The
selection of gloves depends on the nature of task. Cut-resistant gloves are available that are made from a variety of materials
including Kevlar, Dyneema, HexArmor, stainless steel and wire mesh.
Temperature Extremes
PPE to protect workers from cryogenic hazards include non-porous and non-woven protective clothing, full foot protection, insulated
gloves, safety glasses or a face shield (based on nature of the task). PPE is often used to prevent burns. Insulated gloves,
protective clothing, foot protection, and eye/face protection should be chosen based on the hazard assessment.
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Administrative
Personal
Programs to maintain or
build resilience or coping
skills. Development of
support system.
Communication with
family physician.
Increase awareness of
substance abuse signs
and symptoms.
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Abuse by co-workers
Communication with
counsellors. Report to
family physician.
Participate in treatment
programs and return to
work programs.
Time log used to track
time. Work-life balance
programs are utilized.
Work activities are
isolated from home time.
Time is effectively
managed. Days off are
protected. Appropriate
sleep habits. Social
support system is in
place.
Assertiveness training.
Use of mediation and/or
counselling services.
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Communication devices.
Restricted access. Workplace
design considerations. Panic
alarms. Bright lighting. Mirrors
to facilitate seeing around
corners or hallways,
surveillance cameras.
Design of instruments or
equipment with user-friendly
features.
Development of support
systems to assist in
dealing with stress. Use
of counselling services.
Self-education
concerning new
technologies. Time
management strategies.
Open communication
about stress related to
change. Healthy
lifestyles. Setting realistic
goals. Limiting the need
to multi-task. Technology
time outs. E vacations.
Appropriate sleep
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hours of work
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contaminants.
Program elements for preventing or controlling abuse towards workers in the workplace
Because the scope of abuse of workers is broad, with a wide range of potential internal and external perpetrators and a myriad of
individual considerations, prevention of abuse of workers is multi-faceted. This list of prevention procedures and control techniques
is not all-inclusive, but rather a sample of the complexities that should be considered in a program for dental facilities:
Development, communication and enforcement of policies that indicate no tolerance for any form of violence, harassment, or
abuse including bullying. Awareness sessions for all workers on abuse and violence in the workplace, reporting procedures and
controls.
Staff identification to reduce unauthorized access to areas this includes a requirement of all workers to wear identification
badges. It is suggested that information that is not necessary not be shown on the front to the badge to reduce risk to workers.
Client guidelines and signage to emphasize that abuse will not be tolerated this may include the preparation and dissemination
of client information guidelines, in which client behaviour is discussed, the commitment to no tolerance for abuse against workers
and the encouragement of mutual respect are covered.
Working alone guidelines and communications protocols. Working alone guidelines are required by Alberta occupational health
and safety legislation (OHS Code, Part 28), and must include a written hazard assessment as well as communication protocols
for workers who must work alone.
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Alarm systems and emergency communication devices (panic buttons, etc.). Identification of workers or locations that should be
provided with alarm systems and panic buttons should occur. Once any alarm systems are installed or provided, all workers
should be trained on how to use them and how to respond to alarms.
Identification and correction of high risk facility issues (e.g., isolated areas, parking lots, low lighting, no escape routes, etc.).
There are many risk factors posed by the design of the facility. The dental facility should identify risk factors and work to reduce
the risk in the areas. A checklist would be useful for departments to help identify facility issues contributing to worker risk.
Training programs that include non-violent crisis intervention and assault management techniques.
Working alone
Working alone is addressed in the Alberta OHS Code 2009.
Controls required
Employers must, for any worker working alone, provide an effective communication system consisting of
radio communication,
and land line or cellular telephone communication, or
some other effective means of electronic communication that includes regular contact by the employer
or designate at intervals appropriate to the nature of the hazard associated with the workers work.
If effective electronic communication is not practicable at the work site, the employer must ensure that
the employer or designate visits the worker, or
the worker contacts the employer or designate at intervals appropriate to the nature
of the hazard associated with the workers work.
Alberta OHS Code 2009, Part 28
Work-Life balance
An employer should strive to develop policies and programs that support work-life balance. The following is a list of general work-life
balance policies and programs to consider:
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Flexible time arrangements including alternative work schedules, compressed work week, voluntary reduced hours / part-time
work and phased in retirement
Flexible work locations through the use of technology such as telecommuting and satellite offices
Flexible job design through job redesign, job sharing
Wellness programs
Flexible benefits including paid and unpaid leaves for maternity, parental care giving, educational and sabbatical leaves
Employer sponsored childcare and eldercare practice and referral services
A work-life conflict issue recognized in healthcare is often brought on by workload and work demands. Some strategies to reduce
the impact of increased workloads and work demands include the following:
Identify methods to reduce worker workloads. According to research, special attention is required for managers and
professionals.
Track the costs associated with understaffing and overwork (paid and unpaid overtime, increased turnover, employee assistance
program use, increased absenteeism).
Strive to reduce the amount of time workers spend in job-related travel.
Reduce reliance on paid and unpaid overtime.
Consider a time in lieu system to compensate for overtime.
Develop norms regarding the use of technology (e.g. cell phones, PDA, laptops, email) outside of work time.
Allow workers to say no to overtime without repercussions.
Provide a limited number of days of paid leave per year for caregiver responsibilities (childcare and eldercare) and personal
problems.
Measure the use of work-life practices (e.g. job sharing, compressed work week, etc.) and reward sections of the organization
with high usage. Investigate sections where usage is low.
Increase supportive management. Specifically, organizations should increase the extent to which managers are effective at
planning the work to be done, make themselves available to answer worker questions, set clear expectations, listen to worker
concerns and give recognition for a job well done.
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Shiftwork
The following guidelines will assist in reducing the psychological impacts of shift work.
Good Practice Guideline for Shift Work Schedule Design9
Plan a workload that is appropriate to the length and timing of the shift.
Strive to schedule a variety of tasks to be completed during the shift to allow workers some choice about the order they need to
be done in.
Avoid scheduling demanding, dangerous, safety-critical or monotonous tasks during the night shift, particularly during the early
morning hours when alertness is at its lowest.
Engage workers in the design and planning of shift schedules.
Avoid scheduling workers on permanent night shifts.
When possible, offer workers a choice between permanent and rotating shifts.
Use a forward-rotating schedule for rotating shifts, when possible.
Avoid early morning shift starts before 7 AM, if possible.
Arrange shift start/end times to correspond to public transportation or consider providing transport for workers on particular shifts.
Limit shifts to a maximum of 12 hours (including overtime) and consider the needs of vulnerable workers.
Limit night shift to 8 hours for work that is demanding, dangerous, safety critical or monotonous.
Avoid split shifts unless absolutely necessary.
Encourage and promote the benefit of regular breaks away from the workstation. Where possible, allow workers some discretion
over the timing of breaks but discourage workers from saving up break time for the end of the workday.
In general, limit consecutive working days to a maximum of 5-7 days.
For long work shifts (>8 hours), for night shifts and for shifts with early morning starts, consider limiting consecutive shifts to 2-3
days.
Design shift schedules to ensure adequate rest time between successive shifts.
When switching from day to night shifts (or vice versa), allow workers a minimum of 2 nights full sleep.
Build regular free weekends into the shift schedule.
9
Adapted from Government of the U.K; Health and Safety Executive; Managing shift work HSG256; 2006;
www.hse.gov.uk/pubns/priced/hsg256.pdf
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For a more detailed discussion of controls to prevent or reduce psychological hazards, please consult Best Practices for the
Assessments and Control of Psychological Hazards Vol. 5.
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Competency
Competencies related to workplace Health and Safety include the ability to:
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Competency
A beginning dental practitioner in Canada must be competent to:
Prevent the transmission of infectious diseases by following current infection control guidelines
Recognize and institute procedures to minimize occupational hazards related to the practice of dentistry.
Recognize and manage systemic emergencies which may occur in dental practice
Apply accepted principles of ethics and jurisprudence to maintain standards and advance knowledge and skills
Apply basic principles of practice administration, financial and personnel management to a dental practice.
Demonstrate professional behaviour that is ethical, supercedes self-interest, strives for excellence, is committed to
continued professional development and is accountable to individual patients, society and the profession.
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http://portal.acs.org/portal/acs/corg/content?_nfpb=true&_pageLabel=PP_ARTICLEMAIN&node_id=2231&content_id=WPCP_01231
0&use_sec=true&sec_url_var=region1&__uuid=dae6dbb6-9d03-4590-8995-5325374e8844
American College of Surgeons; Statement by the American College of Surgeons Statement on Sharps Safety; October 2007
http://www.facs.org/fellows_info/statements/st-58.html
BC Centre for Disease Control A Guide for the Selection and Use of Disinfectants http://www.mtpinnacle.com/pdfs/disinfectantselection-guidelines.pdf
Berguer, R., Heller, P.; Preventing Sharps Injuries in the Operating Room; Journal of the American College of Surgeons; 2004;
http://www.facs.org/about/committees/cpc/preventingsharpsinjuries.pdf
Bilsker, D., Gilbert,M., Myette, T.L., and Stewart-Patterson, C. Depression & Work Function: Bridging the gap between mental health
care & the workplace; Retrieved from www.comh.ca/publications/resources/dwf/Work_Depression.pdf
Canadian Centre for Occupational Health and Safety (CCOHS), OHS Answers: Fatigue July 2007; Retrieved from
www.ccohs.ca/oshanswers/psychosocial/fatigue.html
Canadian Centre for Occupational Health and Safety (CCOHS), OSH Answers Safety Glasses and Face Protectors;
http://www.ccohs.ca/oshanswers/prevention/ppe/glasses.html
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Canadian Centre for Occupational Health and Safety (CCOHS), OSH Answers- Chemical Protective Clothing Gloves;
http://www.ccohs.ca/oshanswers/prevention/ppe/gloves.html
Canadian Centre for Occupational Health and Safety (CCOHS), OSH Answers: Substance Abuse in the Workplace, Retrieved from
www.ccohs.ca/oshanswers/psychosocial/substance.html
Canadian Centre for Occupational Health and Safety (CCOHS), OSH Answers How Do I Work Safely with Compressed Gasses?
Updated July 8, 2008; http://www.ccohs.ca/oshanswers/prevention/comp_gas.html
Canadian Centre for Occupational Health and Safety (CCOHS), OSH Answers Electrical Safety Basic Information; updated June 1,
2000; http://www.ccohs.ca/oshanswers/safety_haz/electrical.html
Canadian Centre for Occupational Health and Safety (CCOHS), OSH Answers Fatigue July 2007; Retrieved from
www.ccohs.ca/oshanswers/psychosocial/fatigue.html
Canadian Centre for Occupational Health and Safety (CCOHS), OSH Answers OHS Legislation in Canada; Basic Responsibilities:
http://www.ccohs.ca/oshanswers/legisl/responsi.html
Canadian Centre for Occupational Health and Safety (CCOHS), OSH Answers OHS Legislation in Canada; Due Diligence:
http://www.ccohs.ca/oshanswers/legisl/diligence.html
Canadian Centre for Occupational Health and Safety (CCOHS), OSH Answers OHS Legislation in Canada; Internal Responsibility
System; http://www.ccohs.ca/oshanswers/legisl/irs.html
Canadian Centre for Occupational Health and Safety (CCOHS), OSH Answers Lasers; date last updated July 4, 2003;
http://www.ccohs.ca/oshanswers/phys_agents/lasers.html
Canadian Centre for Occupational Health and Safety (CCOHSOSH Answers: Substance Abuse in the Workplace, Retrieved from
www.ccohs.ca/oshanswers/psychosocial/substance.html
Canadian Centre for Occupational Health and Safety; OSH Answers Cryogenic Liquids and their Hazards; document confirmed
September 1, 2008; http://www.ccohs.ca/oshanswers/chemicals/cryogenic/cryogen1.html?print
Canadian Centre for Occupational Health and Safety; OSH Answers How Do I Work Safely with Cryogenic Liquids?; Document
updated September 1, 2008; http://www.ccohs.ca/oshanswers/prevention/cryogens.html
Center for Disease Control and Prevention, Infection Control in Dental Settings, Oct. 2009; accessed from
http://www.cdc.gov/oralhealth/infectioncontrol/faq/sterilization_cleaning.htm
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Centers for Disease Control and Prevention, USA; Guideline for infection control in health care personnel;
http://www.cdc.gov/ncidod/dhqp/gl_hcpersonnel.html
Government of the U.K, Health and Safety Executive; HSE Information Sheet; Slips and trips in the health services; 09/03;
http://www.hse.gov.uk/pubns/hsis2.pdf
Health Canada Best Advice on Stress Management in the Workplace, Part 1;, 2001; retrieved from www.hc-sc.gc.ca/ewhsemt/pubs/occup-travail/stress-part-1/index-eng.php
Health Canada, Best Advice on Stress Management in the Workplace, Part 2, 2000 retrieved from
www.mentalhealthpromotion.net/?i=promenpol.en.toolkit.162
Health Canada; Guidelines for Limiting Radiofrequency Exposure; date modified 2008-09-12; http://www.hc-sc.gc.ca/ewhsemt/pubs/radiation/83ehd-dhm98/control-operat-limit-eng.php
Myanmar Dental Journal, January 2008; accessed at http://www.mda-myanmar.org/journals/Myanmar-Dental-Journal-2008.pdf
NIOSH; Alert Preventing Needlestick Injuries in Healthcare Settings; 2000-108, November, 1999.
http://www.cdc.gov/niosh/docs/2000-108/
Occupational Safety & Health Administration; Safety and Health Topics Dentistry; comprehensive list of resources accessible at
http://www.osha.gov/SLTC/dentistry/index.html
Stringer, B. et.al.; Effectiveness of the hands-free technique in reducing operating theatre injuries; Occup Environ Med; 2002; 59;
703-707; http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1740223&blobtype=pdf
Surg Cdr SS Chopra*, Surg Cdr SS Pandey (Retd); Occupational Hazards among Dental Surgeons, MJAFI, Vol. 63, No. 1, 2007.
Accessed from http://medind.nic.in/maa/t07/i1/maat07i1p23.pdf
WorkSafeBC; Understanding the Risks of Musculoskeletal Injury (MSI); 2008;
http://www.worksafebc.com/publications/Health_and_Safety/by_topic/assets/pdf/msi_workers.pdf
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10. Administrative controls may include safe work procedures including spill procedures with consideration to the specific product
and manufacturers instructions; waste handling procedures; education of workers in the nature of the hazard; availability of
appropriate equipment and PPE; accommodation for workers with special needs (pregnant workers, persons with sensitivities
or other health issues).
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INDEX
A
Aerosols 5, 8
Alarm systems 36, 43, 47
Allergies 26-7
Amalgams 23, 25
Anxiety 42
Appliances 34
Aprons 27, 30, 32, 41
B
Biohazardous wastes, including 51
Biological hazards 2, 5-6, 8, 10, 12, 25, 56-8
Blood 5, 14-15
Body fluids 5, 14-15
Bright lighting 43-4
Burns 33, 36, 39, 41
C
Castings 22
Chairs 31-2
Chemical Disinfectants 11
Chemical disinfectants 11
Chemical hazards 2-3, 16, 23-5, 56-8
Chemical protective clothing 30
Chemical Storage 53
Chemical wastes 26-7
Chemicals, examples of 17, 19-20
Clothing, chemical-resistant protective 18-19
Competencies 51-2
Compliance 5-6
Compressed gas cylinders 31, 33, 37, 39-40
Contamination 6-7, 27, 41
Control ergonomic hazards 41
Cords, electrical 34-5, 37
Cryogenic agents 33, 36, 39
Cut-resistant gloves 41
Cylinders 20, 33, 37, 39-40
D
De-escalation procedures 43
Decontamination 5, 7, 9, 12, 16, 28, 58
Dental materials 25-6
Depression 42
Design 35-6, 45, 47, 49
Devices 7-8, 21, 25, 37, 40
Disinfectants 11-12, 19, 25, 53
Disposable gloves 11, 28
60
Hazard assessments 3-5, 15, 20-3, 29-31, 33, 36, 40-2, 46,
56
Healthy lifestyles 44-5
HEPA vacuums 22-3
Hierarchy 4, 6, 27, 29, 56, 58
G
GFCIs (Ground fault circuit interrupters) 34, 37
Glove donning, proper 21, 24
Glove removal 21, 24
Gloves 5-6, 13-14, 17-24, 27-8, 32-3, 41, 54, 58
Glutaraldehyde 18, 25
Goggles 15, 28, 33
Ground fault circuit interrupters (GFCIs) 34, 37
I
Immunizations 6, 8, 12-13
Infection prevention 5-6, 9-10, 45, 51
Infectious diseases 5-6, 10, 13, 52
Inhalation 15, 19, 21, 29
Instruments 5, 32, 44
Interlock systems 32, 34-6
M
Masks, Surgical 15
Medical devices 18-21, 24
Mercury 21, 23, 58
Metals 22-3, 36
Microorganisms 7, 10, 13
61
S
Safe needle devices, engineered 7
Safety engineered medical devices (SEMDs) 33, 36, 58
Saliva 5, 8, 15
Scent-free policies 22, 24
SEMDs (safety engineered medical devices) 33, 36, 58
Sharps 33, 36, 39, 41
Shielding 34, 36, 58
permanent 34-5
Shielding materials 32, 34, 41
Shields 15, 19, 22-3, 28, 33, 41
Shifts 45, 49
Skin sensitizer 19, 21
Sleep disorders 42
Spill response procedures 12
Splashes 5, 15
Splatters 5
Sprays 15
Standards, purchasing 31-2, 38, 58
Steam 36
Storage 17, 21, 31, 33, 35, 39
Stress 14, 43-5
Stressors, excessive workplace 42
Substance abuse 42-3, 54
Substance abuse signs 42-3
Substitution 17-25, 33, 36
Surfaces 7-8, 11, 14, 17-18, 35
Symptoms of ergonomic 31-2
62
Technology 3, 44, 48
Training 4, 8, 12, 26, 29, 38, 44, 58
Transmission 10, 13, 24, 52
V
Vaccines 5-6
Ventilation systems 6, 18, 21, 45
Violence 44, 46
63