News + Issues

Sharps exposures: what do I do now?

Saltz, a fourth year student, in clinic at NSU
Saltz, a fourth-year student, in clinic at NSU

“Adam, stop suturing. You’re bleeding.” A look of terror flushed over me as I removed the needle from the extraction socket. I recalled my patient’s mention of Hepatitis B and immediately panicked. Thoughts of possible co-infection with HIV or Hepatitis C set in. My first sharps injury, and there I stood, helpless and afraid, as I bled from a cut to my thumb.

We learn all about these types of occupational exposures in the classroom. But sometimes, when faced with a real-life situation requiring a rapid decision, it can be hard to know how best to react. While we work carefully to avoid these incidents, they can and will happen. It’s our duty to protect our patients and ourselves by quickly managing and accurately reporting these exposures as they occur.

The Centers for Disease Control and Prevention (CDC) provides a helpful resource on infection control. According to the CDC website, occupational exposures in dentistry mostly result from percutaneous or mucocutaneous injury. Blood and other body fluids contaminate needles, sharps and other instruments during dental work and can transmit human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) from an infected source.

However, this seemingly dangerous trifecta of pathogens poses little risk to the dental team. 2013 values from the CDC’s “Infection Control” page estimate the risk of HIV infection at 0.3% and of HCV at 1.8% after a needlestick or sharps exposure. A blood splash or similar exposure to the eye, nose or mouth presents a 0.1% risk for HIV infection.

Unlike HIV or HCV, HBV can pose a more serious threat to unvaccinated persons, with risk for infection upwards of 30 percent, according to the 2013 data from the CDC’s “Infection Control” page on oral health. To protect the health and safety of all workers, the Occupational Safety and Health Administration (OSHA) has mandated certain immunizations and safeguards. The OSHA Bloodborne Pathogens standard, for example, requires employers to offer the hepatitis B vaccination series to employees likely to contact blood and other potentially infectious materials during routine tasks at no cost to them. Vaccinated personnel are at very minimal risk for HBV infection.

A careful medical work-up is critical in determining the status of these infectious diseases. Burying “Any infectious diseases?” among the laundry list of other medically relevant questions, then hurriedly checking “no” and moving on may not elicit a clear answer. Specifying “Do you have any diseases, like HIV, or hepatitis B or C?” may be more helpful and open a useful dialogue. For example, my patient reported being previously treated for HBV, but with further questioning I learned they hadn’t seen a physician in more than 20 years. Viral loads help evaluate infection status, especially in the framework of surgery. Requesting such information from a physician before proceeding is beneficial to you and your patient.

Even with these precautions, work injuries can occur. The CDC immediately advises the provider to wash wounds and exposed skin with soap and water, and to flush mucous membranes with water. A qualified healthcare professional should be contacted to complete an exposure report, in accordance with federal and state guidelines. Items on this report include date and time of the exposure, the procedure being performed at the time and medically pertinent details of the source and exposed person. A more detailed example of such a report can be found on the CDC’s website for “Infection Control.”

As of 2015, the American Student Dental Association (ASDA) supports policies in these exposure incidents. E-12 Sharps Exposure/Bloodborne Pathogens Policy echoes a similar procedural protocol above, encouraging all dental schools to adopt clear and transparent exposure policies of their own. ASDA continues to protect dental students in their work both in and out of the clinic.

If you encounter an occupational exposure, these resources can equip you with the knowledge and tools to proceed. Infectious or not, universal precautions – treating all patients as if they were infectious – should always be observed. Be smart, and stay safe!

~ Adam Saltz, MPH, Nova Southeastern ’17, ASDA editor-in-chief

Adam Saltz

Adam Saltz is a periodontics resident at UT Health San Antonio School of Dentistry. He completed his DMD and MPH degrees at Nova Southeastern University, where he mobilized dental care for thousands of underserved families as a Give Kids A Smile program director. He also served as ASDA editor-in-chief from 2016-2017. When he’s not on the tennis court, you can catch him watching Bruins hockey.

You may also like ...

Leave a Reply

Your email address will not be published. Required fields are marked *