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Occupational Health and Safety - Dental
Frequently Asked Questions and Answers
General
What are the main employee’s duties under
the new OHS Act?
What is an injury under the Workers
Compensation Act?
Where can an injury occur?
What is Injury management and return to
work plan?
What are the main employer’s duties for
Injury Management and Return to Work after a workers
compensation injury?
What are the main employee’s duties for
Injury management and return to work after a workers
compensation injury?
What is a Register of Injury?
What are the recommended procedures for
the resolution of grievances and industrial disputation in
the dental setting?
Hazards and Risk Management
What are the main employer’s obligations
under the new OHS Act?
What are the main employee’s obligations
under the new OHS Act?
Which are the five types of potential
hazards in a dental practice?
What is involved in the three stage
approach to injury reduction?
What are the most common Risk Factors in
Manual handling?
What are the Employees duties to prevent
manual handling injuries?
What are the most common Risk Factors in
seated postures?
What are the most common Risk Factors in
standing postures?
Effective Infection Control
What are the measures used to control
infection in a dental practice?
What are the recommendations for hand
washing in the dental setting?
When do we wash and dry hands in the
dental practice?
When do dental staff need to wear
Protective apparel (also called PPE – Personal Protective
Equipment)?
When do dental staff need to wear
protective eye wear?
When do dental staff need to wear Masks?
List some recommendations for general
cleaning and decontaminating in the dental setting?
How do we handle sharps in the dental
practice?
How do we handle clinical waste in the
dental practice?
What is the recommended practice for
cleaning of instruments and equipment in the dental
practice?
What is the recommended immunisation for
dental staff?
What are the main
employer’s duties under the new OHS Act?
Employers must ensure the
health, safety and welfare of their employees when at work by:
(a) maintaining places of work under their control in a safe
condition, and ensuring safe entrances and exits;
(b) making arrangements for ensuring the safe use, handling,
storage and transport of plant and substances;
(c) providing and maintaining systems of work, and working
environments, that are safe and without risks to health;
(d) providing the information, instruction, training and
supervision necessary to ensure the health and safety of
employees;
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What are
the main employee’s duties under the new OHS Act?
Employees must take reasonable care of
the health and safety of themselves and others. Employees must
co-operate with employers in their efforts to comply with
occupational health and safety requirements. All persons must
not:
- interfere with or misuse things
provided for the health, safety or welfare of persons at
work;
- obstruct attempts to give aid or
attempts to prevent a serious risk to the health and safety
of a person at work;
- refuse a reasonable request to assist
in giving aid or preventing a risk to health and safety;
- not disrupt the workplace by creating
undue health and safety fears without reasonable excuse.
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What is an
injury under the Workers Compensation Act?
For workers compensation purposes,
injuries fall within two categories:
o Significant Injury — is a workplace injury that is likely to
result in an employee being unable to come into work for more
than 7 days; and
o Other Injury — is any injury that is not a significant
injury.
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Where can an injury occur?
An injury for the purposes of a workers
compensation claim is one that arises out of regular work
duties, that is, an injury caused in the workplace.
An injury occurring while an employee is travelling to and
from work is also an injury that may be subject to a workers
compensation claim.
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What is Injury management
and return to work plan?
An injured employee must gradually
return to the workplace, and their regular duties. This
involves a three-way collaboration between the treating
doctor, the workers compensation insurer and the employer.
Together they create a Return To Work Program that allows for
the injury to be managed effectively and the worker to return
to their previous employment.
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What are the main
employer’s duties for Injury Management and Return to Work
after a workers compensation injury?
a) What to do after an injury
As soon as the Employer becomes aware of an injury, the
following steps must be taken:
- In the case of a possible SIGNIFICANT
INJURY, notify your workers compensation insurer within 48
hours of becoming aware of the injury;
- In the case of an injury that is
probably not significant, notify the workers compensation
insurer within 7 days of becoming aware of an injury that
does not appear to be significant;
- For significant injuries,
participation in the creation of an Injury Management Plan
with the workers compensation insurer and the nominated
treating doctor. Once that plan is finalised, you must
comply with it;
- Formulation of a Return to Work Plan
that is consistent with the Injury Management Plan;
- The employer must send an injured
worker’s claim form, and any other document received in
respect of that claim, to the workers compensation insurer
within 7 days of receiving that document.
- Provide any other document in the
employer’s possession, or which is reasonable to obtain, to
the insurer within 7 days of receiving the request;
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What are the main
employee’s duties for Injury management and return to work
after a workers compensation injury?
- Register any injury whether serious
or not, in the register of injury book
- Give notice of the injury as soon as
possible to the employer, or anyone designated by the
employer. Notice can in writing or verbally. It must be
given before an injured worker resigns voluntarily from the
job where they were injured. (Notice of gradual hearing loss
must be given in writing, but can be given after offer
voluntarily resigning from a job)
- See a doctor of their choice if
treatment is needed and get a WorkCover medical certificate.
- Comply with the return to work plan
- Make a claim by completing and giving
to the employer a Workers Compensation claim form (a claim
form is usually only needed if seeking benefits in excess of
any authorised by the insurer under provisional liability).
- Co-operate with the insurer, in
particular complying with any reasonable request to provide
specific information in addition to that provided on the
claim form
- Attend (if necessary) a medical
examination with a medical practitioner arranged and paid
for by the employer at a reasonable time.
- Provide up to date WorkCover medical
certificates
- If it is a significant injury (total
or partial incapacity for a continuous period of more than 7
days, whether or not they are working days):
- Advise your insurer when asked to
do so, who your Nominated Treating Doctor is (i.e. doctor
of your choice)
- Comply with the insurer’s Injury
Management Treatment plan.
- Once the insurance company has
provided the employer with a notification number, the
employee should get and keep a copy of this number.
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What is a Register of
Injury?
This may take the form of a book of
printed leaflets available from the insurer, or your own loose
leaf folder may also be used. All injuries and “near misses”
should be recorded on these sheets. The Information must
include date, time, place of injury, type of injury, body part
injured, cause if known, persons involved and what action if
necessary was taken (eg first aid required), who witnessed or
assisted the injured worker and any further action required.
This information should be passed to the employer and/or
practice manger and confidentiality maintained. A risk
assessment of the practice procedures should follow to prevent
this accident or injury recurring.
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What are
the recommended procedures for the resolution of grievances
and industrial disputation in the dental setting?
The procedures for the resolution of
grievances and industrial disputation concerning matters
arising in relation to OH &S matters shall be in accordance
with the following procedural steps.
(i) Procedure relating to a grievance of an individual
employee:
(a) The employee shall notify (in writing or otherwise) the
employer as to the substance of the grievance, request a
meeting with the employer and/or OH&S committee for bilateral
discussions and state the remedy sought.
(b) The grievance must initially be dealt with as close to its
source as possible, with graduated steps for further
discussion and resolution at higher levels of authority.
(c) Reasonable time limits must be allowed for discussion at
each level of authority.
(d) At the conclusion of the discussion, the employer must
provide a response to the employee's grievance, if the matter
has not been resolved, including reasons for not implementing
any proposed remedy.
(e) While a procedure is being followed, normal work must
continue.
(f) The employee may be represented by an industrial
organisation of employees for the purposes of each procedure.
(ii) Disputes between an employer and the employees - In the
event of a question, dispute or difficulty arising:
(a) The matter shall first be raised with the supervisor and
agreement sought.
(b) If the dispute is not resolved at this level, the matter
may be discussed between the union delegate and
representatives of employer or management.
(c) Should the dispute remain unresolved, the matter may be
referred to an official of the relevant union, who shall
discuss it with senior management. If necessary, the State
Secretary of the union and the relevant employer association
may also be involved in discussions at this stage.
(d) In the event of no agreement being reached at this stage,
advice should be sought from WorkCover.
(e) Reasonable time limits will be allowed for discussion at
each level of authority, but undue delay should be avoided.
(f) While the procedure is being followed, normal work will
continue.
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Hazards & risk management
What are the main
employer’s obligations under the new OHS Act?
Under the Occupational Health and Safety
Regulation 2001 employers are required to:
- Identify any foreseeable hazard that
could harm employees or other persons in the workplace
- Assess the risk of harm where a
hazard is identified
- Eliminate or control any reasonably
foreseeable risk and properly use and maintain these control
measures
- Review risk assessment processes and
any measures adopted to control risks
- Inform employees of any potential
risk and provide them with information and/or training as
necessary to cope with the risk
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What are the main
employee’s obligations under the new OHS Act?
- Be aware of possible hazards
- Report hazards to employers
- Consult with employers regarding
hazard identification, assessment and control
- Cooperate with review of processes.
- Cooperate with their employer in
completing a Risk Identification Checklist, Risk Assessment
Form and Risk Control Form
- Report to their employer or employee
representative any problems observed or experienced with
tasks involving repetitive or forceful movement or both,
and/or maintenance of constrained or awkward postures.
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Which are the five types
of potential hazards in a dental practice?
- Physical Hazards
- Mechanical/electrical hazards
- Chemical Hazards
- Biological Hazards
- Psychological Hazards
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What is involved in the
three stage approach to injury reduction?
1. Risk identification,
2. Risk assessment and
3. Risk control
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What are the most common
Risk Factors in Manual handling?
Some of the known risk factors
associated with manual handling and/or occupational overuse
syndrome are:
- awkward body postures;
- poorly designed workstations,
equipment, machinery and tools not matched to the employee,
including the effects of vibration and sudden impact forces;
- poorly designed tasks, that is,
factors such as employee position, forces required and the
design and placement of equipment;
- work organisation factors which may
contribute to demands placed on employees, such as required
output, duration and variation of tasks, number and duration
of pauses and the urgency of deadlines;
- inappropriate/poor arrangement of job
design, for example, the requirement to perform the same
repetitive movements; and
- new employees, or those returning to
work after an extended absence, being required to perform
repetitive movements without a period for adjustment.
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What are the Employees
duties to prevent manual handling injuries?
Employees have a duty to cooperate with
their employer and supervisors in accordance with Chapter 6 of
the National Standard for Manual Handling [NOHSC: 1001(1990)]
Employees should also assist employers in their efforts to
identify, assess and control risks arising from repetitive or
forceful movement or both, and/or maintenance of constrained
or awkward postures.
Employees should, where workable:
- participate in, and use, the training
provided in safe work systems, procedures and practices;
- participate in, and use, the
particular training provided in specific tasks, skills and
techniques;
- use the mechanical aids or devices
and the associated training provided;
- take any rest breaks provided.
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What are the most common
Risk Factors in seated postures?
- Any regular seated position must have
adequate lower back support (even when sitting upright).
- Sustained forward leaning postures
(to assist, read, write, type,) must be minimized.
- Regular extended forward reaches (to
reach distant items on benches, instruments/equipment in the
surgery) must be eliminated
- Regular twisting of neck and trunk
(to refer to items on work benches, instruments, at the side
of a monitor, the monitor itself) must be eliminated
- Adequate foot support at work station
reception must be provided (or not using footrest provided
effectively).
- Positioning of instruments both
static and dynamic must be planned
- Adequate lighting for all tasks must
be provided
- Minimize distances from regularly
accessed items.
- Screen heights, placement, distance
and brightness need to be correctly adjusted to the
individual
- Keyboard & mouse locations and wrist
support need to be addressed.
- Telephone use, frequency; posture
adopted during use must be monitored
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What are the most common
Risk Factors in standing postures?
Standing postures in a dental practice
may result in straining of the spine and lower limbs
It is important to minimize:
- Sustained leaning forward postures,
stooping.
- Repetitive twisting.
- Any regular extended forward reaches.
- Any sustained poor postures.
- Sustained/repeated bending below
waist/knees.
- Poor access to instruments.
- Poor lighting.
- Limited/restrictive space to
comfortably conduct tasks.
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Effective Infection Control
What are the measures used
to control infection in a dental practice?
There are two different sets of
precautionary measures used to deal with Infection Control in
a day-to-day setting:
1. Standard Precautions – involve the use of safe work
practices and protective barriers, with all patients receiving
care in health care facilities regardless of their diagnosis
or presumed infectious status. They require a system of
procedures undertaken for every patient who visits a dental
practice, without exception. These are the minimum acceptable
standards of practice for infection control
Standard Precautions refer to infection control practices
where all human secretions, particularly blood and saliva in
dentistry, are assumed to be potentially infectious.
2. Transmission Based Precautions - precautions necessary for
the care of patients who are known or suspected to be infected
by pathogens spread by airborne, droplet or contact
transmission. Transmission based precautions apply in those
situations where Standard Precautions may be insufficient to
prevent transmission of infection and are used in addition to
standard precautions.
Types of transmission based precautions:
- Airborne precautions – apply to
patients known or suspected to be infected with pathogens
than can be transmitted by the airborne route, e.g.. TB,
measles, chickenpox.
- Droplet precautions – Droplet
precautions are designed to reduce the risk of droplet
transmission of an infectious agent. Droplet transmission
involves contact of the conjunctiva or the mucous membrane
of the nose or mouth of a susceptible person with large
particle droplets. e.g.. mumps, influenza, rubella.
- Contact precautions – are designed to
reduce the risk of transmission of micro organisms by direct
contact, usually direct skin contact, e.g. herpes simplex,
hepatitis A and MRSA
If additional help or information is needed, a consultation
with the hospital, or Area Infection Control Practitioner,
local Public Health Unit or the NSW Infection Control
Resource Centre may be of assistance
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What are the
recommendations for hand washing in the dental setting?
Hand washing is the single most
important procedure for preventing transmission of infection.
Hands are to be washed after touching blood, body substances,
and contaminated items, whether or not gloves are worn.
Wash hands immediately after gloves are removed, between
patient contacts, and when otherwise indicated to avoid
transfer of micro organisms to other patients or environments.
It may be necessary to wash hands between tasks and procedures
on the same patient to prevent cross contamination of
different body sites.
Research has shown that long finger nails and artificial nails
increase the risk of micro organisms growing under nails or in
cracked nail polish. Therefore:
- finger nails should be short and
clean
- nail polish and artificial nails
should not be worn
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When do we wash and dry
hands in the dental practice?
- before commencing work
- before and after treating a patient
- after removing gloves
- before leaving the clinic
- after visiting the toilet
- after hands are visibly soiled
- after blowing or wiping of the nose
- before meals
- before leaving for home
- after smoking
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When do dental staff need
to wear Protective apparel (also called PPE – Personal
Protective Equipment)?
The workplace should provide protective
apparel and equipment and be readily accessible to the health
care worker. The requirement of the type of protective
clothing depends on the equipment to be used, the procedure
and the individual clinical decision.
For dental procedures the following protective apparel must be
worn if there is likelihood of splashes or contamination with
blood, saliva or other body substances:
- gloves
- eye and /or facial protection
- masks
- fluid resistant gown or plastic
aprons made of impervious material.
The health care worker must wear footwear
that is enclosed and protects against injury if sharp objects
are accidentally dropped.
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When do dental staff need
to wear protective eye wear?
Protective eye wear must be worn while
performing procedures where there is a likelihood of splashing
or splattering of blood or other body substances.
Staff should wear protective eyewear - either goggles or face
shield. Generally spectacles used for vision are not suitable
protective eyewear and there may be a need to add either side
panels or over goggles. Where face shields are worn, masks
should also be worn.
Patients should be offered protective eye wear. Should a
patient refuse to do this, the potential risk is to be
explained and documented in the patient’s notes.
Staff should wear protective eyewear when any cleaning
procedure is to be undertaken.
Protective eyewear should be cleaned between patient
appointments according to the manufacturer’s instructions.
Assistants’ eyes should also be protected from curing lights.
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When do dental staff need
to wear Masks?
The type of mask selected to be worn
should be appropriate to the type and risk of the procedure. A
selection of masks should be made available for different
procedures.
Staff should wear masks where there may be the likelihood of
splashing or spraying of blood or other body fluids
- the mask should be fitted as per
manufacturers instructions
- the body of the mask should not be
touched during the procedure
- a mask must be discarded once it has
been worn and not used again
- a mask should not be worn around the
neck or carried in a pocket of coats or uniforms
- disposable masks should be disposed
after each patient appointment.
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List some recommendations
for general cleaning and decontaminating in the dental
setting?
- Wear general purpose gloves when
cleaning.
- Surgeries should be damp dusted first
thing in the morning, before patients arrive, at the end of
the morning session if time permits, and again at night
before closing down the surgery.
- Use a neutral detergent for general
cleaning. Disinfectants should not be used for general
cleaning. Check manufacturers’ recommendations for cleaning
detergents to be used on the dental chair and unit. Water
and detergent are very effective in removing bio-burden
o Detergent used for wiping down should be sprayed into a
tissue or cloth not on surfaces.
- Use disposable cloths (e.g. Chux) or
tissues for wiping surfaces. The cloth should be thrown away
after use. Re-usable cloths and sponges harbour and become a
great breeding ground for micro-organisms and therefore
should not be used.
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How do we handle sharps in
the dental practice?
The potential of transmission of blood
borne infections such as hepatitis B, hepatitis C and HIV is
greatest when needles and sharps are handled. Sharps must be
handled with care at all times and procedures devised so as to
minimize the risk of injury during procedures and the cleaning
of reusable instruments.
Special care should be taken to prevent injuries during
procedures, when cleaning reusable sharp instruments and
during disposal of used sharps.
Sharps should be disposed of as soon as practical following
use.
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How do we handle clinical
waste in the dental practice?
Clinical waste is waste that has the
potential to cause sharps injury, infection or offence.
Clinical waste includes the following types of waste:
- Sharps
- human tissue (excluding hair, teeth
and nails)
- bulk body fluids and blood
- visibly blood stained body fluids and
visibly blood stained disposal material and equipment.
- Clinical waste should be segregated
(i.e. placed in appropriate leak-proof bags or containers)
and contained at the source of generation.
- Clinical waste bags must have
sufficient strength to contain the waste safely
- Clinical waste bags and containers
should not be overfilled. Overfilling will prevent closure
and increase the risk of rupture in transit
- Clinical waste bags should be tied or
sealed, then stored in a secure place for collection.
- the facility must be worn when
handling clinical waste bags and containers
- Clinical waste bags and containers
should be yellow colour with the ‘Biohazard’ symbol printed
on the bag or container.
- Mobile garbage bins, trolleys,
storage areas and protective personal apparel used for the
transportation and storage of clinical waste should conform
to the requirements of the NSW Health, Waste Management
Guidelines for Health Care Facilities.
Workers involved in disposal of blood or
body substances must:
- wear appropriate personal protective
equipment
- minimise splashing or contamination
to mucosa or skin.
- slowly pour liquid waste down a drain
connected to a sanitary sewer system and flush immediately
after disposal
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What is the recommended
practice for cleaning of instruments and equipment in the
dental practice?
Cleaning is an essential pre-requisite
for all disinfection or sterilisation processes as organic
residue (bio-burden) may prevent heat or steam penetration
required for effective disinfection or sterilisation.
Any instrument or equipment that comes into contact with
intact skin must be cleaned before it is used.
Any instrument or equipment that is required to be disinfected
or sterilised must be cleaned before it is disinfected or
sterilised.
Cleaning agents shall be used to remove residual soil and
organic matter from instruments and equipment.
The process of cleaning must involve water and physical or
mechanical action (such as instrument washers) and a cleaning
agent such as detergents.
The cleaning process involves:
- rinsing the items with cold or
lukewarm water to remove debris such as blood, mucous and
tissue
- use of water, a chemical agent such
as detergent and physical action (ultrasonic cleaner)
- where there is no instrument washer
available, equipment should be rinsed with water, cleaned
manually (hand scrubbing) using warm water, detergent and a
brush then rinsing with running water
- abrasive cleaners or steel wool
should not be used as the surface of instruments can be
damaged
- brushes should be cleaned, autoclaved
and stored dry.
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What is the recommended
immunisation for dental staff?
Under the Occupational Health and Safety
Act 2000, employers have a duty to ensure the health, safety
and welfare of all people at their workplace. In addition, the
Act provides that all employees have a duty to co-operate with
anything done to improve their health and safety at work.
The following immunisation should be included:
- Tetanus
- Hepatitis B
- Varicella (chicken pox)
- TB (BCG vaccination in areas where TB
is prevalent)
- Flu
Employer responsibilities
Employers have a responsibility to:
- Offer vaccination program
- Supply employees with information so
that they can make an informed decision about vaccination.
This includes information on the importance of reporting
adverse events;
- Maintain strict confidentiality about
screening results/vaccination status of employees;
Employee responsibilities
All employees must:
- Take reasonable steps to be aware of
their own infectious disease/vaccination status
- Comply with relevant OH&S policies
- Refusal to participate in vaccination
program must accompany a signed declaration absolving the
employer from any responsibility.
Who vaccinates?
Vaccines are to be administered by doctors, registered nurses
under medical direction or registered nurses who are authorised
to give immunisations.
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