Dr. Katherine Schrubbe, RDH, BS, M.Ed, PhD, is an independent consultant with specialization in OSHA, dental infection control, high quality assurance and threat management. She is an invited speaker for proceeding education and learning and training programs for local and also national dental institutions, colleges of dentisattempt and also exclusive dental groups. She has actually hosted positions in corporate and also academic dentistry and continues to add to the scientific literary works.

You watching: Engineering and work practice controls

By Dr. Katherine Schrubbe, RDH, BS, MEd, PhD.

Key elements of Bloodborne Pathogens Standard are regularly overlooked.

For all dental exercise settings, OSHA’s Bloodborne Pathogens (BBP) Standard (29 CFR 1910.1030) offers the fundamentals for a safe worklocation, prescribing safeguards to safeguard employees versus health dangers caused by bloodborne pathogens. The Standard locations requirements on employers whose workers can be sensibly anticipated to contact blood or various other possibly infectious materials (OPIM), such as unaddressed huguy tworries and specific body fluids.1

All of the aspects of the BBP Standard are necessary and work-related together to carry out a comprehensive setup for dental healthtreatment worker safety. Many dental team members are acquainted via numerous points, such as requirements for an exposure manage setup and also personal protective devices (PPE), the possibility to obtain a hepatitis B vaccicountry and the implementation of universal prealerts.2,3

Some elements of the BBP Standard, yet, are frequently overlooked. Based on personal anecdotal and also field observation, the ideas of design controls and also job-related practice controls are not constantly assigned the importance – or the attention – they deserve. Dental healthcare employees not only are exposed to humale bloodborne pathogens, however also to toxic chemicals in the worklocation. But OSHA makes it clear: Engineering controls, and also occupational practice controls, are crucial to all at once safety.2,4

OSHA’s longstanding policy is that design and also work-related exercise controls must be the major suggests used to alleviate employee exposure. Wherever before feasible, elimination or substitution of a risk is many desirable, complied with by design controls. Administrative or occupational exercise controls might be proper in some situations wbelow engineering controls cannot be imposed, or when various actions are essential after the implementation of the brand-new design controls. Personal protection devices is the least desirable, yet might still be reliable.5 The pyramid chart listed below illustrates least reliable to a lot of efficient methods for reducing job-related expocertain.


With regard to all healthtreatment, including dentisattempt, design controls refer to controls (e.g., sharps disposal containers, self-sheapoint needles and safer clinical gadgets, such as sharps via engineered sharps injury protections and also needleless systems) that isolate or rerelocate the bloodborne pathogens risk from the workarea, according to OSHA. Work exercise controls refer to controls that alleviate the likelihood of exposure by altering the manner in which a job is performed (e.g., prohibiting recapping of needles by a two-handed technique).3 In other words, it’s product versus procedure. Engineering controls are commodities or devices that have actually been made or produced to aid minimize the threat of injury; job-related practice controls are strategies or processes that dental team members need to implement to mitigate the danger of injury and also practice as safely as possible.

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Engineering controlsAccording to C.H. Miller, engineering controls isolate or remove the hazard from the worklocation. In dentistry, this indicates the use of gadgets that remove or reduce chances of exposure to blood and saliva. These include sharps containers, needle security gadgets, red-bags, rubber dams, high-volume evacuation, instrument cassettes and mechanical instrument cleaners. The controls offered have to be examined and kept or replaced on a reserved basis.4,6

Although the requirement to use engineering controls has actually been in effect since the 1992 BBP typical, because work expocertain to bloodborne pathogens from accidental sharps injuries in healthtreatment and other work settings ongoing to be a severe problem, Congress forced change of the BBP conventional. Because of this, the Needlestick Safety and also Prevention Act was signed right into legislation on November 6, 2000, to encertain that OSHA’s BBP typical collection forth in greater detail OSHA’s need for employers to identify, evaluate and implement safer medical devices, such as needleless devices and sharps via engineered sharps protections.1,7

The Needlestick Safety and Prevention Act took impact on April 18, 2001, and also mandated additional demands for maintaining a sharps injury log and for entailing non-managerial healthtreatment employees in identifying, evaluating and picking efficient design and also job-related practice controls.1,7 In dental practice settings, this is a sound strategy to promote safety and team involvement. As new sharps safety tools become available in the dental marketarea, team members need to carry them right into their exercise and also test them out. They should trial the brand-new tool for a period of time, ask for feedback from one an additional, record the safety trial and also recognize if the tool is something that might be imposed to promote a safer workplace.

Work Practice ControlsMiller points out that work-related methods have the right to be supplied to reduce the likelihood of exposure by changing the manner in which a job is performed; all measures need to be perdeveloped in such a manner regarding minimize the spraying and also spattering of oral fluids.4,6 Also, occupational exercise controls help in transferring out jobs in a safe manner to mitigate the opportunity of a sharps injury. Miller gives the complying with list of occupational practice controls, although it is not all-inclusive:

Flush mucous membranes as quickly as feasible if contaminated through transmittable materials.Recap dental needles by a mechanical indicates, such as forceps or one more cap-holding gadget, or by utilizing a one-handed “scoop” method.Prohilittle bit the cutting, bfinishing or breaking of contaminated needles before disposal.Discard contaminated needles and also other disposable sharps in appropriate sharps containers.Prohibit the overfilling of sharps containers.Place contaminated reusable sharp tools in containers that are puncture-resistant, leak-proof, colored red or labeled through the biodanger symbol, till correctly processed.Eliminate hand-to-hand also passing of contaminated sharp instruments.Prohibit eating, drinking, smoking cigarettes, using cosmetics and also handling call lenses in locations where there is job-related expocertain, such as the dental operatory or instrument processing locations.Eliminate the storage of food and drink in refrigerators and also cabinets, on shelves or on countertops wright here blood or saliva might be existing.Store, move or ship blood and saliva, and also items contaminated with blood or saliva (extracted teeth, tconcern, impressions that have actually not been decontaminated), in containers that are closed, prevent leakage, colored red or labeled with a biohazard symbol.3,4

OSHA’s mission is to ascertain safe and also healthful functioning problems for all functioning males and also womales by setting and also enforcing criteria and by giving training, outreach, education and learning and assistance.8 When OSHA standards are followed, job-connected injuries, illnesses and also fatalities decrease drastically. At times, dental team members may comsimple that doing so is cumbersome, overwhelming and also challenging, but OSHA has actually made a far-reaching difference in a positive means. Worker deaths in America are down on average, from around 38 worker deaths a day in 1970 to 14 a day in 2017; and also worker injuries and illnesses are dvery own – from 10.9 events per 100 employees in 1972 to 2.8 per 100 in 2017.9

It is crucial for all dental healthtreatment employees to comply with all of the facets of the OSHA standards, and also it is imperative that exercise owners and also management groups are committed to implementing all aspects of the OSHA requirements. This is the only way to encertain that dental team members have the right to carry out their duties safely in the practice and that the dental facility is a safe area to work and care for patients.


Miller CH, Palenik CJ. Infection Control and Management of Hazardous Materials for the Dental Team. fifth ed. St. Louis: Mosby Elsevier; 2013; 247.

Editor’s note: Dr. Katherine Schrubbe, RDH, BS, M.Ed, PhD, is an independent compliance consultant through expertise in OSHA, dental infection control, quality assurance and risk administration. She is an invited speaker for proceeding education and learning and training programs for neighborhood and also national dental organizations, schools of dentisattempt and exclusive dental teams. She has actually hosted positions in corporate as well as scholastic dentistry and continues to add to the clinical literary works. Dr. Schrubbe deserve to be reached at .