Performing dental procedures without the use of personal protective equipment (PPE) was common among dental healthcare practitioners (DHCP) in the past. Although eyesight is precious, many people did not appreciate the risk of injury associated with projectiles and infectious materials emitted from the oral cavity while performing dental procedures. In the past, eyewear primarily provided needed assistance in magnification. Loupes became popular and often included small spectacles attached to an arm that connected to a headband. DHCP wore these proudly, often in the lifted position when not in use as though it was a royal crown. True eye protection from devices was minimal at best.
The chances of serious eye injury in a dental office are relatively high. Projectiles, harsh chemicals, heat, or infectious materials are among the traumatic injuries that could occur without the use of proper eye protection. The Occupational Safety & Health Administration (OSHA) has developed eye protection standards and requirements for DHCP. Education has helped DHCP realize the importance of wearing eye protection and the risks associated in their absence. Today, with current knowledge, it would be irresponsible to perform even a simple dental procedure without the use of appropriate eye protection.
The types of hazards DHCP face during their workday include impact, chemical, dust, heat, and infectious materials. Most impact accidents result from flying debris, such as that coming from rotary or hand instruments. Although often smaller than a pinhead, hard projectiles can cause serious injury. Direct contact to chemical splashes, mists, vapors, or fumes account for a significant percentage of eye injuries in a dental office. Exposure occurs by not wearing eyewear, when coverage is incomplete, or if eyewear does not fit properly. Dust may also be an opportunity for injury in the dental office. For example, when trimming acrylic or preparing to mix powders with liquids, a significant amount of dust can be generated. Elevated temperatures can be present working with steam sterilizers (heat under pressure) or in the laboratory. Eyewear use is mandatory in such cases. In addition, transmission of infectious agents can occur through a spatter and droplets. It is extremely important for DHCP to know where eyewash stations are located and how to use them properly. Practice of the eyewash station should be included in initial and annual training sessions.
Rights and responsibilities
Federal regulations include a general standard created by OSHA (CFR 29 Part 1910.133 - Eye and Face Protection) and reference to the issue of eye protection in its Bloodborne Pathogens Standard (CFR 29 Part 1920.1030). Therefore, eye protection is the responsibility of the employer.
OSHA specifies a hierarchy of safety and health controls. Engineering controls are the most effective control for dental environments. Engineering controls are control methods that isolate or remove an occupational hazard from the workplace. The next most effective are work practice controls, which reduce the likelihood of exposure by altering the manner in which a DHCP performs a given task. OSHA requires employers to use PPE as controls to further reduce employee exposure to hazards.
Employers must provide correct and necessary equipment for employees to protect themselves from risks. It is important for all DHCP to understand and comply with OSHA standards. OSHA regulations have the power of law and non-compliance is punishable by citations and fines. Of course, adverse publicity associated with such instances is quite undesirable. Working together, employers and employees can make the workplace environment safer.
OSHA requires the use of appropriate eye or face protection to shield DHCP from flying particles, potentially infectious materials, molten metal, liquid chemicals, acids or caustic liquids, chemical gases or vapors, or potential injurious light radiation. Eye protection must include front, top, and side protection (e.g., detachable side protectors, such as clip-on or slide-on side shields) when the hazards present are flying objects.
DHCP who wear prescription lenses can incorporate safety features onto their spectacles or eye protection designed to cover the prescription lenses without adversely affecting the correct positioning. Appropriate equipment filter lenses for use in the workplace are also useful.
In addition, the OSHA Bloodborne Pathogens Standard includes a goal to minimize or eliminate eye exposure to patient blood and other potentially infectious materials through proper eye protection.
The most common form of eye protection in dental environments is spectacles (more commonly called glasses). Major components of spectacles include:
- the front or frame, which is the portion designed to hold the lens or lenses;
- the temple, which extends from the frame to the ear and is designed to hold the device into place; and
- side shields, which are attached to the top of the frame and the temples and provide angular protection from impact hazards.
Spectacles are available in a variety of component combinations.
Frames must fit comfortably and correctly to offer the necessary protection. The bridges are available in a variety of sizes, are fixed or adjustable, and may have adjustable nose pads with pliable arms. The temples can fit over the ear, can be either fixed or adjustable, and are available in metal or plastic. Headband temples are also available for easy adjustment and an added secure fit. Side shields provide angular protection from impact hazards. Side shields may be part of or attached to the temple, removable, solid, and available in tinted or clear.
It is imperative that all PPE - including eye protection - fit properly. Training of employees must include recommendations concerning proper use of eye protection, including when and which types of eye protection to use during a specific situation. Again, employers must provide correct forms of PPE to employees at no cost.
OSHA requires that eye and face protection comply with tenets issued by the American National Standards Institute, ANSI (Standard Practice for Occupational and Educational Eye and Face Protection, ANSI Z87.1-1989 R1998). ANSI is a private, non-profit organization that administers and coordinates voluntary industry standardization and conformity assessment systems in the United States. ANSI provides guidelines for assessing eye/face hazard situations in many occupations and issues recommendations for protective devices to a particular hazard. ANSI sets performance standards for eye and face protection. Evaluation of each type includes:
- how easily they are cleaned and disinfected;
- effects of corrosion;
- light transmission; and
- three types of impact resistance.
Everyday an estimated 1,000 eye injuries occur in American workplaces. Over $300 million is lost in production time, medical expenses, and workers compensation. This enormous financial cost does not include the personal toll on injured workers. OSHA has implemented regulations to help reduce workplace eye injuries. When OSHA regulations including eye protection are implemented in dental practices, the overall level of safety increases, while the number of exposures or accidents decreases.
What is the greatest contributor to eye injuries? Nearly three out of five eye injuries that occur on the job are among people not wearing eye protection. Almost 40 percent were not wearing the appropriate eye protection at the time of the accident; those lacking side shields or with inadequate impact resistance.
Also, don’t forget about taking steps to prevent patient eye injuries. Providing your patients with eye protection makes sense during any procedure. By providing your patients with protective eye wear - and properly disinfecting it after every use - you’ll be providing a service to your patients and keeping them safe.
Ginny Jorgensen is the Clinical Procedures instructor at Portland Community College, Dental Assisting Program, Portland, Ore. She can be reached at (503) 977-4036 or by e-mail at [email protected].