Preventing Needlestick Injuries for a Safer Practice

Dentistry is a noble profession that involves caring for patients’ oral health and well-being. However, like any medical field, it comes with its own set of occupational hazards. One of the most concerning risks dental professionals face is the potential for needlestick injuries. In Ontario, as in many other places, strict protocols and safety measures are in place to mitigate these risks. In this blog post, we will explore the importance of preventing needlestick injuries in dentistry, the specific protocols that are followed in Ontario, and the safety measures that every dental practice should implement to protect its staff. 

Needlestick injuries are accidental punctures or injuries caused by needles or other sharp instruments. In a dental setting, these injuries typically result from mishandling syringes, disposing of contaminated sharps, or other unfortunate accidents. The consequences of needlestick injuries can be severe, posing immediate and long-term risks to dental professionals: 

1. Risk of Infection: The most immediate concern is the potential transmission of bloodborne pathogens, including HIV, hepatitis B, and hepatitis C. 

2. Emotional Stress: Needlestick injuries can cause emotional distress, anxiety, and uncertainty about one’s health, which can affect the well-being of dental professionals. 

3. Financial Costs: Treating needlestick injuries can be costly, often requiring medical evaluation, follow-up tests, and medications. 

4. Loss of Productivity: Injuries can result in time away from work, impacting patient care and the practice’s overall efficiency. 

Ontario, like many regions, has stringent safety protocols in place to prevent needlestick injuries in dental practices. These protocols stem from multiple regulatory bodies, mainly Public Health Ontario, the Government of Ontario with respect to the Occupational Health and Safety Act, and the Royal College of Dental Surgeons. Public Health Ontario mandates, with reference to the Occupational Health and Safety Act Regulation 474/07 – Needle Safety, that needles used in dental practice should be safety-engineered medical sharps whenever possible, which is also recommended as a best practice by the RCDSO.  Safety engineered medical sharps, or SEMS, are devices that has a built-in sharps injury protection mechanism such as an attached sheath covering the needle or scalpel after use or needles that retract after use. They are designed to help protect workers from needle stick injuries. Other types of safety devices include blunt needles or needle-less systems. The RCDSO also recommends the following protocols: 

• Always use extreme caution when passing sharps during four-handed dentistry.  
• Needles must remain capped prior to use.  
• Needles must not be bent, recapped or otherwise manipulated by using both hands. 
• Following use, needles must be recapped as soon as possible by using a one-handed scoop technique or a commercial recapping device.  
• When suturing, tissues must be retracted using appropriate instruments (e.g. retractor, dental mirror), rather than fingers.   
• Remove burs from handpieces immediately following the procedure.  
• Identify and remove all sharps from trays before cleaning instruments. 
• Used sharps must be collected in a clearly labelled puncture-resistant container.   

In addition to these protocols, some additional safety measures to include: 

1. Sharps Container Placement: Proper placement and labeling of sharps containers in treatment areas and throughout the dental practice are essential to safe disposal. 

2. Regular Training: Dental professionals must undergo regular training and education on sharps safety and bloodborne pathogen exposure. 

3. Post-Exposure Procedures: A clear protocol for post-exposure evaluation and follow-up should be in place, so that any needlestick injury can be addressed promptly, as recommend by CSA Z314—18.  

4. Use of Personal Protective Equipment: When manually cleaning soiled dental instruments it is essential to don puncture-resistant gloves to protect staff members from dental instruments with sharp tips.  

5. Employee Training: Conduct regular safety training for all staff members. This includes proper handling of needles, sharps disposal, and what to do in the event of an injury. 

6. Safety Culture: Promote a culture of safety within your practice, encouraging open communication and reporting of any potential hazards or incidents. 

In addition to these protocols, dental practices should consider the placement of sharps containers. It’s a subjective decision for each dental practice, but in my time as a consultant, I have seen dental practices placing the sharps containers under the sinks in the operatories. I recommend, however, keeping the sharps container on operatory countertops and not obstructing it with other items, and to keep out of reach of children.  Obstructed and often hidden sharps containers create a higher risk of needle puncture during disposal. 

Preventing needlestick injuries in dentistry is paramount to ensuring the well-being of dental professionals and the quality of patient care. Ontario, like many regions, has implemented rigorous safety protocols to protect its dental workforce. However, it is the responsibility of every dental practice to implement additional safety measures and cultivate a culture of safety to minimize the risk of needlestick injuries. By following these protocols and safety measures, we can ensure that dental professionals in Ontario and beyond work in a safer and more secure environment. 

As always, if you have any questions about the policies and procedures for your own practice – we’d be happy to help!