29,99 €
Mehr erfahren.
- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Sprache: Englisch
'NVQs for Dental Nurses' provides trainee dental nurses with a core companion to the National Vocational Qualification (NVQ) Level 3 in Oral Healthcare. The book offers comprehensive support on mandatory units of the course in addition to supplying material on the optional units most common to clinical dentistry.
The second edition has been substantially revised and restructured in line with the newly updated NVQ course.
Sie lesen das E-Book in den Legimi-Apps auf:
Seitenzahl: 534
Veröffentlichungsjahr: 2013
Ähnliche
Contents
Introduction to the Second Edition
Acknowledgements
1 The N/SVQ
Knowledge specifications
2 Unit 1: Ensure Your Own Actions Reduce the Risk to Health and Safety (ENTOA)
Employers’ responsibilities
Employees’ responsibilities
(1) Fire regulations
(2) COSHH (Control Of Substances Hazardous to Health)
(3) RIDDOR (Reporting Of Injuries, Diseases and Dangerous Occurrences Regulations)
(4) Safe Disposal of Hazardous and Special Waste
(5) Manual handling
(6) Ionising radiation legislation
(7) Security in the workplace
3 Unit 2: Reflect on and Develop Your Practice (HSC33)
History of dental nursing
General Dental Council
Statutory registration of dental nurses – standards guidance
Factors that may influence development and progression
Reflective practice
Staff appraisals
Non-verifiable CPD
4 Unit 3: Provide Basic Life Support (CHS36)
Basic biology
Current BLS guidelines
DRSABC in detail
Rescue breathing
Recovery
Handing over to specialists
Choking
Legislation
5 Unit 4: Prepare and Maintain Environments, Instruments and Equipment for Clinical Dental Procedures (OH1)
Micro-organisms
Infection, inflammation, immune response
Infection control
Cleaning of the hands
Use of personal protective equipment
Cleaning of the clinical environment
Cleaning of equipment, hand pieces and instruments
Autoclaves
Protection of staff by immunisation
Hazardous waste disposal
Sharps injury procedure
6 Unit 5: Offer Information and Support to Individuals on the Protection of Their Oral Health (OH2)
Anatomy of the teeth
Anatomy of the supporting structures
Dental caries
The role of saliva in oral health
Periodontal disease
Oral cancer
Prevention of dental caries
Prevention of periodontal disease
The effect of general health on oral health
Evaluation of knowledge, skills and motivation
Communication skills
Consent
Confidentiality
7 Unit 6: Provide Chairside Support During the Assessment of Patients’ Oral Health (OH3)
Anatomy of the skull
Muscles of mastication and facial expression
Nerve supply to the oral cavity
Blood supply to the teeth and gingivae
Salivary glands
Tongue
Tooth morphology
Occlusal classification
Dental clinical assessments
Extra-oral soft tissue assessment
Intra-oral soft tissue assessment
Tooth charting
Eruption dates of deciduous and permanent teeth
Periodontal tissue assessment
Assessment of occlusion for orthodontics
Methods used to carry out assessments
First aid and medical emergencies
Materials used in oral assessment
8 Unit 7: Contribute to the Production of Dental Images (OH4)
Nature of ionising radiation
Effect of ionising radiation on the body
Principles of dental radiography
Types of views used in dental radiography
Radiographic techniques
Formation of the image
Role of the dental nurse during imaging
Film processing
Role of the dental nurse during processing
Mounting and viewing films
Processing faults
Quality assurance
Staff safety
Ionising radiation legislation
9 Unit 8: Provide Chairside Support During the Prevention and Control of Periodontal Disease and Caries and the Restoration of Cavities (OH5)
Periodontal disease
Dental caries
Treatment of periodontal disease
Role of the dental nurse during periodontal treatment
Treatment of dental caries
Local anaesthesia
Classification of cavities
Cavity preparation
Moisture control during tooth restoration
Role of the dental nurse during tooth restoration
Tooth restorations
Amalgam restorations
Composite restorations
Glass ionomer restorations
10 Unit 9: Provide Chairside Support During the Provision of Fixed and Removable Prostheses (OH6)
Summary of anatomy and tooth morphology
Treatment options to replace missing teeth
Fixed prostheses
Instruments
Impression materials
Role of the dental nurse during fixed prosthetics
Luting cements
Post-crowns
Bridges
Veneers
Inlays
Removable prostheses
Full and partial acrylic dentures
Full and partial chrome cobalt dentures
Immediate replacement dentures
Other prosthetic procedures
Role of the dental nurse during removable prosthetics
Orthodontic appliances
11 Unit 10: Provide Chairside Support During Non-surgical Endodontic Treatment (OH7)
Summary of dental anatomy and dentition
Diagnosis of irreversible pulpitis
Treatment option considerations
Patient consent
Use of rubber dam in non-surgical endodontics
Non-surgical endodontic techniques
Role of the dental nurse during endodontic procedures
Use of antibiotics in endodontics
12 Unit 11: Provide Chairside Support During the Extraction of Teeth and Minor Oral Surgery (OH8)
Reasons for tooth extraction
Summary of tooth and root morphology, eruption dates, skull anatomy nerve supply
Treatment option considerations
Simple extractions
Role of the dental nurse during extractions and MOS
Surgical field considerations
Pre- and post-operative instructions
Surgical extractions
Complications of extractions and MOS
Use of antibiotics with MOS procedures
Patient monitoring
Pain and anxiety control
13 The VRQ and Question Examples
Principles of infection control in the dental environment
Assessment of oral health and treatment planning
Dental radiography
Scientific principles in the management of plaque-related diseases
Glossary of Terms
Index
This edition first published 2009
© 2009 Carole Hollins
© 2003 Blackwell Munksgaard
Blackwell Publishing was acquired by John Wiley & Sons in February 2007. Blackwell’s publishing programme has been merged with Wiley’s global Scientific, Technical, and Medical business to form Wiley-Blackwell.
First published 2003
Second edition published 2009
Registered office
John Wiley & Sons Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, United Kingdom
Editorial offices
9600 Garsington Road, Oxford, OX4 2DQ, United Kingdom
2121 State Avenue, Ames, Iowa 50014-8300, USA
For details of our global editorial offices, for customer services and for information about how to apply for permission to reuse the copyright material in this book please see our website at www.wiley.com/wiley-blackwell.
The right of the author to be identified as the author of this work has been asserted in accordance with the Copyright, Designs and Patents Act 1988.
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission of the publisher.
Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books.
Designations used by companies to distinguish their products are often claimed as trademarks. All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book. This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold on the understanding that the publisher is not engaged in rendering professional services. If professional advice or other expert assistance is required, the services of a competent professional should be sought.
Library of Congress Cataloging-in-Publication Data
Hollins, Carole.
NVQs for dental nurses / Carole Hollins. — 2nd ed.
p.; cm.
National vocational qualifications for dental nurses
Includes bibliographical references and index.
ISBN 978-1-4051-9256-9 (pbk. : alk. paper) 1. Dental assistants—Outlines, syllabi, etc.
I. Title. II. Title: National vocational qualifications for dental nurses.
[DNLM: 1. Dental Assistants—Examination Questions. Wu 18.2 H741n 2009]
RK60.5.H65 2009
617.60233—dc22
2009012271
A catalogue record for this book is available from the British Library.
1 2009
Introduction to the Second Edition
This textbook has been written for those Dental Nurses studying to qualify as Dental Care Professionals (DCPs) via the National Vocational Qualification (NVQ) route. It is the second edition, and its writing has been prompted by the recent changes to the structure of the Level 3 NVQ qualification in dental nursing, as well as the introduction of compulsory registration of all DCPs with the General Dental Council.
The updated NVQ qualification consists of 11 units, all of which are mandatory, and which have incorporated the changes to dentistry and relevant legislation since the first edition. Nine of them cover the general areas of dental practice in which the majority of dental nurses will work, while the other two units cover the concept of ‘life-long learning’ and basic life support. This book provides the underpinning theoretical knowledge required to study and understand all of the areas of dental nursing covered by the NVQ qualification, while the workplace competencies are achieved at the chairside as witnessed assessments.
In addition, the final chapter introduces information on the new Vocationally Related Qualification (VRQ), which has replaced the Independant Assessment as the written examination of the NVQ qualification. Examples of question styles are included, but not the answers – it is hoped that the readership will enjoy discovering these as they read the text book and learn the subject of dental nursing!
Carole Hollins
Acknowledgements
Grateful thanks are extended once again to the staff and patients of Kidsgrove dental practice for their eager participation in posing for various photographs – who said attending for dental treatment couldn’t be fun!
I especially wish to thank Tracey Evans for her unstinting help, support and ‘modelling skills’ during the writing and compilation of the book; she is a dental nurse and tutor par excellence, and an inspiration to student dental nurses throughout Stoke-on-Trent.
I also thank the General Dental Council for their very kind permission to reproduce their Standards Guidance document in part, and express huge appreciation again to various other illustrators for their ongoing support.
Finally, to all of the staff at Wiley-Blackwell, a huge ‘thank you’ for their continued and very friendly help and support throughout the writing of this book.
1
The N/SVQ
The concept of qualification by N/SVQ has been developed around the recognition of the competence of candidates to perform a range of tasks to the standards required for their successful employment. For this qualification, the candidates will be dental nurses who are employed by any of the following employers:
Formal qualifications are not required by candidates wishing to undertake this N/SVQ in Dental Nursing, but they must be employed in a suitable dental workplace where the necessary opportunities to gain evidence for the completion of the qualification are provided. As the dental workplace can be a hazardous environment for numerous reasons, the qualification is not approved for any candidates under the age of 16 years.
This dental nursing qualification is specifically involved with direct chairside tasks and the support provided to dentists and dental care professionals (DCPs; such as hygienists and therapists) during a range of dental treatments. However, considerable underpinning knowledge of topics such as anatomy, dental instruments and materials, and dental equipment is also required. The theoretical knowledge needed in these areas should be provided by formal classroom teaching.
The decision on whether a candidate is deemed to be ‘competent’ or ‘not yet competent’ in a given task is determined by the assessment of evidence produced by the candidate to show that they can perform each of the tasks covered by the qualification, in a competent manner in the workplace. The assessments are carried out by trained and qualified assessors, and for this qualification an assessor is a dentist, qualified DCPs or another professional who is competent and qualified in certain areas of healthcare, such as a radiographer.
The evidence considered acceptable can be produced either directly or indirectly. Examples of each are given below.
Direct evidence:
Indirect evidence:
The N/SVQ in Dental Nursing qualification consists of 11 mandatory units:
The first unit and the last eight form the basis of general dental practice, while the second and third units have been added to cover areas of competence that are necessary in accordance with the National Occupational Standards for dental nursing. Each unit is made up of a number of ‘elements of competence’, which describe all of the tasks that the dental nurse must be able to carry out competently. Every element of all 11 units must be carried out competently to achieve the N/SVQ qualification. In addition, the factual knowledge evidence from various areas of the 11 units is tested in the form of a written Vocationally Related Qualification (VRQ), and this will also have to be successfully completed before the dental nurse can register as a qualified DCP with the General Dental Council.
The four broad sections of the N/SVQ syllabus to be covered by the VRQ are discussed in detail in Chapter 13, and are summarised below:
It can be seen then, success in the N/SVQ requires evidence of competency in all of the chairside tasks, as well as proof of knowledge and understanding of the underpinning information required to carry out the tasks to a consistent standard.
To assist the dental nurse in completing the N/SVQ successfully, City & Guilds provide the necessary paperwork for candidates to build a portfolio of performance evidence, which provides a record of their competence in the workplace. To be able to cover the whole range of tasks in which the dental nurse must be assessed, each element of competence is accompanied by the following information:
This textbook is designed to provide the required theoretical information to cover the knowledge specifications of all 11 units, so that the dental nurse has a thorough understanding of their role in the dental team, and can perform the necessary tasks to an acceptable standard at all times.
Knowledge specifications
Each of the 11 units is covered chapter by chapter in the book, and the table of contents lists those areas of the dental nursing syllabus that are discussed in each chapter. Where the same information is required in several units, it is discussed fully in the chapter to which it is initially referred, and then summarised in any relevant later chapters.
Several knowledge specifications of one unit may be repeated in others because they are relevant to both. An example of this occurs in Units 6 and 8, which both refer to the dental nurse requiring ‘a factual knowledge of the primary and secondary dentition and the average dates of eruption’. The knowledge specification is covered in detail in Unit 6, where it is referred to initially, and is then summarised in Unit 8 where it is referred to again. It is hoped that this will help to minimise the amount of cross-referencing required by the reader.
Each of the knowledge specifications fall into one of the following descriptions, which indicates the depth of understanding that the candidate needs to acquire:
These can be interpreted and explained as follows:
These explanations indicate the depth of understanding that is required by the candidate for each of the knowledge specifications throughout this N/SVQ qualification. A full list of the knowledge specifications covered by each unit is given at the start of each chapter. Chapter 13 is devoted to an explanation of the VRQ, the subjects it covers, and examples of the style of questions that may appear in the written paper. The answers can all be found within the text of the book.
The book also contains numerous diagrams and photographs to help illustrate key points referred to in the text. In addition to the glossary provided by City & Guilds in their portfolio documentation, a ‘Glossary of Terms’ has been included in the end of this book to give descriptive definitions of key words and phrases used within the text and that have specific meaning here.
2
Unit 1: En sure Your Own Actions Reduce the Risk to Health and Safety (ENTOA)
All employers, including dental practitioners, have responsibilities towards their staff and any other persons on their premises in relation to safe working practices and safety at work. These are governed by the Health and Safety at Work Act 1974.
In the dental workplace, ‘any other persons’ include: patients and their escorts, visiting utility workers, such as postal deliverers and meter readers, and visitors such as repair and maintenance personnel.
The aim of the Act with specific reference to the dental workplace is to protect all persons at work, and in particular:
All work places must also have a current Health and Safety Law poster on display within the premises, for all staff to see (Figure 2.1).
Figure 2.1 Health and safety poster.
Employers’ responsibilities
Under the Act, all employers must ensure, as far as is reasonably practicable, that the health and safety of all persons on the premises is protected – and this must be achieved by carrying out a risk assessment of the workplace activities that occur on the premises. This is a specific requirement under the Management of Health and Safety at Work Regulations 1999.
A risk assessment is merely a detailed examination of the normal day-to-day activities that occur in the workplace in an effort to identify those that have the potential to cause harm to anyone on the premises – these are called the hazards. Once the hazards have been identified, a set of precautions can be determined that will prevent or minimise the risk associated with each hazard, thereby ensuring the safety of all those on the premises.
Recording the findings of the risk assessment is considered ‘best practice’, but is a legal requirement for all employers with five or more employees. As any relevant laws and regulations are updated, areas of the risk assessment may need to be reconsidered and updated too.
A typical process of risk assessment in the workplace can be summarised as follows:
Employees’ responsibilities
All employees are legally required to take reasonable care for their own and others’ health and safety, and to co-operate with their employer to this effect while carrying out their normal workplace activities. Indeed, it is an offence for an employee to intentionally break the workplace rules and policies in relation to health and safety, whether this causes harm to themselves or others, or not.
As the majority of dental nurses training in practices tend to be young persons, the following two sets of regulations are also pertinent to dental practices:
These regulations stipulate that the risk assessment of the dental workplace carried out must take into account the following points:
Compliance with Health and Safety Law in the dental workplace involves all of the following, and all except those relating to ionising radiation will be covered in this Unit.
(1) Fire regulations
Fire is a daily hazard that can occur in any workplace environment, but a risk assessment of the dental workplace will identify several specific fire hazards, as follows:
In addition, all dental equipment is electrically operated and may short circuit, malfunction or spark and cause a fire at any time, especially if not serviced and maintained correctly.
Larger electrical items of dental equipment, such as the dental chair and inspection light, or autoclaves, have to be serviced and maintained by trained personnel on a regular basis. However, smaller portable items such as curing lights can be inspected for electrical safety by a general electrician, in a process known as portable appliance testing (PAT). This should be carried out annually, with each appliance having the plug, fuse size and wiring inspected for wear and tear. If all is well, a sticky label is applied to indicate that the appliance is PAT compliant, and the due date of the next PAT inspection (Figure 2.2).
Figure 2.2 PAT label on electrical item.
In general, the commonest causes of fire in the workplace are:
Recent legislation (July 2007) to ban cigarette smoking in enclosed public places and the workplace has reduced the risk of fire from this source considerably.
Fire precautions in the workplace are governed by the Fire Precautions Regulations 1997, and require the employer to assess what fire precautions are needed by carrying out a risk assessment of the premises (as described previously) and by complying with the following.
Emergency routes and exits:
Figure 2.3 Fire exit pictogram.
Figure 2.4 Fire instructions.
Fire safety inspectors also advise:
Fire extinguishers vary depending on the type of fire that they are designed to fight; fires are classified as follows:
In the dental workplace, the likeliest causes of fire shown above suggest that extinguishers to fight fire classes A, B, C and E should be available. The content of each fire extinguisher varies, depending on its recommended use, and is identifiable by a coloured label on the extinguisher. The extinguishers themselves are now all red in colour so that they can be easily located. (Figure 2.5)
The labels themselves are coded as follows:
Fire extinguishers must be inspected yearly and replaced as necessary, and dental practices should have a written fire safety policy with which all staff are familiar, so that a set procedure is known and followed by all.
Figure 2.5 A fire extinguisher.
(2) COSHH (Control Of Substances Hazardous to Health)
COSHH is a legal requirement for employers, whereby all chemicals and potentially hazardous substances used in the workplace are assessed for risk of injury to staff, so that reports can be written for each and kept updated for quick reference in the case of accident or injury. Problems are only likely to occur if the substances and materials are not handled and used correctly, so it is very important that all members of staff are made aware of the hazards involved, and the correct handling of the substances.
Hazardous substances include any that have been labelled as dangerous by the manufacturer, and these are easily recognised by the use of a universal system of symbols which indicate the specific hazard of the substance. So, they may be classed as ‘toxic’, ‘harmful’, ‘corrosive’ or ‘irritant’ (Figure 2.6).
Figure 2.6 COSHH hazard signs. Source: Levison’s Textbook for Dental Nurses, 10th edn, C. Hollins, 2008, Wiley-Blackwell.
These symbols will appear on the substance packaging, along with information on the actions to take in the event of an accident; all of this information will be included in the COSHH report of each substance.
Other hazardous substances found specifically in the dental workplace are:
The COSHH assessment will follow the stages set out below for each of the substances:
Each substance will have the relevant details entered onto an evaluation sheet, set out in the same way for ease of reference (Figure 2.7). The evaluation sheets for all substances used in the workplace should be kept in several folders throughout the premises, for ease of access by all staff. The evaluation sheets of those substances posing serious harm if misused or involved in spillages should also be kept in an ‘emergency file’, with medical emergency details included.
The COSHH regulations were amended most recently in 2004, to outline the principles of ‘best practice’ that every workplace is expected to adhere to in an effort to control the exposure of staff to substances hazardous to health. Their particular relevance to the dental workplace is as follows:
Figure 2.7 Example of COSHH assessment sheet. Source: Levison’s Textbook for Dental Nurses, 10th edn, C. Hollins, 2008, Wiley-Blackwell.
To comply with these principles of ‘best practice’, the dental workplace has to consider the following control measures in an effort to reduce the risks to staff when handling any substances hazardous to health.
Three hazardous substances used in the dental workplace on a daily basis by most staff require special mention in relation to COSHH. These are:
Mercury
Mercury is a liquid metal that is mixed with various metal powders to form dental amalgam – this is a material used to fill teeth (see Unit 8). It is classed as a hazardous substance because it is toxic, and it can enter the body in the following ways:
Dental amalgam is still the commonest material used to fill teeth, so mercury is present in significant amounts in the majority of dental workplaces. Exposure to the hazards mercury poses cannot easily be avoided, but the risks can be minimised by following simple rules designed to limit the chances of staff contact.
Inhalation
Figure 2.8 Waste amalgam tub.
Figure 2.9 Waste amalgam capsule tub.
Absorption
Ingestion
Handling of mercury spillages
The use of capsulated amalgam products will limit the likelihood of a large mercury spillage, but the capsules themselves can rupture during use, releasing liquid mercury into the environment although on a much smaller scale. All spillages of mercury, no matter how small, must be reported to the senior dentist and recorded in the workplace ‘Accident Book’. This will provide a written record of any accident or incident that has occurred on the premises, and that could have potentially harmed someone. It must include the following details:
In the unfortunate event of any long-term health effects, this report will provide valuable evidence about whether correct procedures were followed, and whether the accident/incident was avoidable or not.
If mercury is spilled, it tends to form into liquid globules or small balls. In this shape, the liquid can easily roll around and be difficult to pick up, indeed larger globules often break into smaller ones when attempts are made to handle them. The correct actions to take after a mercury spillage are therefore very important, to prevent further contamination and spread into the workplace environment.
If a small spillage occurs:
Never use the dental suction unit, or the vacuum cleaner, to suck up spilt mercury – their use will release toxic mercury vapours into the workplace. Alternatively, the lead foils present in intra-oral x-ray film packets can be used to gather the globules together and scoop them up. However, since they too are now classed as toxic special waste, their handling and use in this manner should be avoided if possible.
To avoid the release of small globules into the workplace, the amalgamator machine (Figure 2.10) should have a lid on and be stood on a foil tray to collect any spillages without them contaminating the workplace. Any globules collected by these methods can be simply tipped into the waste amalgam store.
Figure 2.10 An amalgamator.
If a larger spillage occurs:
Figure 2.11 Mercury spillage kit.
If the size of the spillage is significant, such as a full bottle of mercury, or if globules rolled into inaccessible areas, the work area must be sealed off and closed down. The Health and Safety Executive must be informed of the spillage, and Environmental Health will attend to clear away the contamination professionally and safely.
Acid etchant
Acid etchant is used during the placement of composite (tooth-coloured) fillings (see Unit 8). As the name suggests, it is acidic and can therefore chemically burn soft tissues, such as within the patient’s mouth or the skin of those handling the substance. The material itself is 33% phosphoric acid, in either a liquid or gel form.
All staff handling the etchant must be wearing the correct PPE, and when placed within the patient’s mouth it must be confined to the tooth undergoing restoration. Very careful aspiration must be used while the material is washed off the tooth, so that it does not fall elsewhere and burn the patient’s oral mucosa. To aid this, the acid etchant is usually brightly coloured so that it is easily visible – for instance some manufacturers produce a bright pink liquid and others a bright blue gel.
The manufacturer’s instructions for use, contained within the packaging of the material, will show the necessary symbol indicating a hazardous substance, and will provide details of the first-aid actions to take if an accident occurs, in accordance with COSHH regulations.
Bleach (and other disinfectants)
All disinfectants have a huge role to play in the decontamination of work areas and fixed equipment in the dental practice. Bleach, which is sodium hypochlorite, is used in many situations:
Other disinfectants include a variety of aldehydes and isopropyl alcohol products, often sold as spray solutions or pre-soaked wipes.
Bleach has an unpleasant taste and smell, and is chemically irritant to soft tissues. It can cause tissue damage to the mouth and digestive tract, the eyes, and the lungs if strong vapours are inhaled. Appropriate PPE must be worn whenever it is handled, and fresh solutions made daily for the uses indicated above should be held in lidded containers so that the noxious chlorine vapours do not become overpowering.
Disinfectant bottles of any solutions used will show the necessary hazardous substance symbol, and give the necessary first-aid actions in the event of an accident, in line with COSHH regulations (Figure 2.12).
Figure 2.12 Hazardous substance label.
(3) RIDDOR (Reporting of Injuries, Diseases and Dangerous Occurrences Regulations)
In addition to any minor accidents or incidents that may occur in the workplace, a separate set of regulations exist that cover those accidents and incidents classified as ‘significant events’. All workplaces have a duty to report these significant events to the Health and Safety Executive, which will investigate the matter and determine if correct procedures were followed, if the event was avoidable or not, and ultimately if an employer is legally to blame and therefore liable to prosecution.
Major injuries that must be reported are:
The notifiable dangerous occurrences which require reporting to the Health and Safety Executive are:
All other accidents occurring on the premises, no matter how minor and whether involving staff or patients, should be recorded in the ‘Accident Book’. This also includes any violent assaults or attacks occurring on the premises, and these should also be reported to the police.
Compliance by all staff with Health and Safety laws should avoid the occurrence of a significant event on the premises, although sometimes purely unavoidable incidents can occur, even at a fully compliant workplace. Investigation of these incidents by the Health and Safety Executive often results in a change to recommended working practice, thereby reducing the chances of a similar event occurring again. This is called ‘significant event analysis’ and illustrates successful risk assessment in action.
Besides the obvious hazards associated with the dental workplace, more general hazards and risks that require consideration are:
(4) Safe disposal of hazardous and special waste
There are three types of waste produced by all dental workplaces:
Non-hazardous waste
Non-hazardous waste is produced at reception and in staff rest room areas, rather than in the clinical areas. It is normal household waste, consisting of paper, writing or computer products, waste food and its containers, packaging of stock deliveries, etc. It is no more of a hazard in the workplace than it is in the home, and therefore requires no special disposal.
Hazardous waste
The definition of hazardous waste is ‘any items that are potentially contaminated with body fluids’, and this encompasses all of the following dental waste:
Those items that are not sharp must be disposed off in yellow/orange hazardous waste sacks, which are sealed with identifying tags and must be collected only by a hazardous waste handling company. They must be stored safely at the dental workplace before collection, away from possible contact with the public, and must be incinerated once they have been removed from the premises.
Some hazardous waste products are sharp and may cause penetrating injuries and infection. They are particularly dangerous in the transfer of pathogenic microorganisms. They include all of the following:
These items must be disposed of in rigid ‘sharps bins’, coloured yellow and with a puncture-proof base and a sealable lid that cannot be reopened once closed. They must be sealed once they are three-quarters full (Figure 2.13).
Ideally, the sharps items should be placed in these bins directly by the dentist rather than the dental nurse, to avoid having to pass sharp items between each other and thereby reducing the risk of a sharps injury.
If a ‘dirty’ sharps injury does occur, the immediate hazard to the casualty is the transfer of a blood-borne infection from the patient. The most serious of these are hepatitis B or C, and acquired immune deficiency syndrome (AIDS). Staff vaccinated against hepatitis B will be protected from the disease, but the other two diseases are both fatal and it is vital that the correct procedure is followed when a ‘dirty’ sharps injury occurs, as follows:
Figure 2.13 A sharps box. Source: Levison’s Textbook for Dental Nurses, 10th edn, C. Hollins, 2008, Wiley-Blackwell.
The Environmental Regulations that are in force with regard to hazardous waste are summarised below:
Special waste
All waste classed as special is potentially harmful but cannot be disposed off by incineration as other hazardous waste can. Further regulations governing their safe disposal are as follows:
Otherwise, separate containers provided by the waste collector must be used to store each type of special waste on the premises for up to six months, before collection (Figure 2.14).
Figure 2.14 Developer waste container.
In particular, the containers used to store waste amalgam and amalgam capsules must contain a mercury-absorbing chemical, to avoid vapour release. All other special waste containers must be of a rigid plastic design, shaped so as not to fall over and spill their contents easily, and clearly labelled with their contents. They must be stored in an area of the workplace that has no public access, to avoid accidents.
(5) Manual handling
In the majority of dental workplaces, the usual manual handling that occurs is the transport of boxes containing stock items, or the movement of waste containers in and out of storage. Hospital departments and dental clinics may also require staff to be involved with the movement of disabled, sedated or unconscious patients too, and separate and specific training must be given in these areas by the employer.
Lifting heavy or awkward items incorrectly can result in all kinds of injuries to staff, and employers must ensure that, as far as reasonably practicable, they adhere to the regulations laid down in the Manual Handling Operations Regulations 1992. These were further revised in 2002, and state:
While carrying out an assessment of any manual handling and lifting that has to be carried out in the dental workplace, the following points must be considered when deciding whether the task is hazardous or not:
If each point is taken separately, it can be seen that much can be done to avoid injury to staff during moving and handling activities.
Weight and dimensions
The heavier the load and the greater its dimensions, the more difficult will be its handling and the more likely injury will occur, so consider the following:
Awkward movements and frequency
Examples include twisting etc. while lifting or moving a load. The more times the move is carried out, the more likely it is to cause injury, so consider the following:
Excessive movements
Pushing and pulling lighter loads is not usually a problem, but when heavier loads are involved they must either be split into smaller units first or a trolley or other handling aid must be used. In most instances, large boxes of stock can be opened and put into their place of storage individually, to avoid having to push or pull them into position.
Distance and stairs
It makes sense to move objects the minimum distance whenever possible, and to avoid having to carry them up and down stairs manually. The place of storage for stock should be carefully considered, to avoid repetitive strain injuries to staff, and a lift must always be used if available. Otherwise, a trolley or other handling aid needs to be provided.
Physical ability and medical conditions
Elderly or unfit staff are more likely to injure themselves while moving and handling, by over-estimating their own capabilities. The following must be considered:
Training
A correct handling technique should be taught to all staff involved in moving and lifting objects in the dental workplace, and this may involve the following:
(6) Ionising radiation legislation
The type of ionising radiation used in dentistry is ‘x-rays’, an invaluable tool for accurate diagnosis of some dental problems, but their misuse or overuse can be dangerous to staff and patients alike. The legislation concerning the safe use of x-rays in the dental workplace is fully covered in Unit 7 – Contribute to the Production of Dental Images.
(7) Security in the workplace
Although it is unlikely that dental practices will have just one or two members on the premises during normal working hours, this situation can occur during holiday times or when several staff are attending courses so no patient appointments are set. In the interests of staff safety, it would be advisable for the premises to be locked during these times so that staff are not left vulnerable and open to attack.
All employers have a responsibility to maintain the security of both the workplace premises and the safety and security of their staff. In addition, all staff have a responsibility to uphold the security procedures that have been put into place by their employer, to ensure that the safety of the workforce and the security of the premises is never compromised.
Maintaining security during the day
Security of the premises and the safety of the staff during the day are achieved by ensuring that the premises are only accessed by those who have a right of entry. This is more difficult to achieve in large hospital departments and dental clinics than it is in general practice, where the majority of people attending are regular patients who are known by the staff.
However, procedures must be in place to ensure that all visitors to the premises have to pass through a reception point, so that they can be seen and identified by staff. Several methods can be used to achieve this:
When expected visitors attend, such as booked patients, maintenance or repair workers, or stock sales representatives, they will be checked off against the appointment book and then usually held in the reception waiting area.
Patients will have appointment details to be confirmed, while others will have usually phoned to book their attendance with a staff member. In any instance, the following should be the norm to eliminate the risk of any violence towards staff.
