Safety for any medical practitioner should stay apparent, and must be prioritized. Imagine being
a patient and being in a dental practice that’s not clean, where the dentist isn’t sure if the
equipment was sterilized. The worst right?

Patient safety effort are aimed at preventing unintentional harm whilst caring for patients. In the
care of patients through surgical procedures professionals find it quite difficult to keep accidents
from happening. This became the main reason why patient safety was introduced as a discipline
in the medical field.

The hygiene and safety protocols in dental practices will vary considerably. Due to the nature of
dentistry and the treatments that are performed, the risk of exposure to contagion of bacteria for
professionals and patients is high. In addition to the impossibility of maintaining the
recommended safety distances, it is influenced by the fact that the virus spreads mainly through
respiratory drops (aerosols) and by direct contact with infected secretions.

1: Health and Safety, Occupational Hazards and Infection Control in the Dental
Workplace

It is essential that dental nurses are aware of the hazards in the dental workplace and the health
and safety actions that you can take to avoid harm. Human error is responsible for most risks in a
workplace. and working in the UK.

If there are five or more employees in the workplace, the employer must have a written health
and safety policy statement. Does your workplace require this? If it does, find out where it is
located and who is responsible for it.

The employer’s responsibilities
Every employer should:

• Provide a health and safety policy
• Provide a safe working environment with no health risks
• Maintain the workplace, equipment and all work appliances in a safe condition

• Display the HIPPAA’s health and safety law poster in a location where all staff can easily refer
to it
• Ensure staff are aware of, and comply with, the provided health and safety policies and
procedures
• Ensure staff are trained in the safe handling and storage of any hazardous substances and
equipment
• Ensure risk assessments (see next section) are carried out and recorded
• Review health and safety performance at least annually and be aware of and investigate any
failures or concerns.

Health and Safety Considerations in the Workplace
The workplace room temperature should reach at least 16 °C after one hour and all rooms should
have thermometers to check this. Interestingly, there is no legislation covering temperatures that
are high!

Enclosed workplaces such as a dental surgery should be ventilated with sufficient fresh or
purified air to minimize exposure to dust, mercury, chemicals, nitrous oxide and disinfectant vapors. An open window will usually provide adequate ventilation, but
mechanical ventilation or air-conditioning units could be considered. These should provide at least 5–8 liters per second of fresh (not recycled) air per occupant. The relative humidity should
be between 40% and 70%.

All dental practices should have a first aid kit as well as the required emergency kit
(see Chapter 2). All dental surgeries must also keep a stock of emergency drugs on the premises.
Surgeries in which inhalational sedation is performed have further requirements to fulfil, to
ensure nitrous oxide and any other gas levels are minimized.

Terms to note
Disinfection: a process by which the number of viable harmful micro-organisms is reduced in an
area, e.g. a worktop in a dental practice. Disinfection does not get rid of certain micro-organisms,
such as some viruses, or destroy certain forms of harmful micro-organisms, such as spores.
Therefore, it is only used for cleaning those areas of a dental clinic that only need to be

acceptably safe. Disinfection can by carried out using special chemicals called disinfectants or by
using heat.

Inhalational sedation: reducing or relieving anxiety using nitrous oxide and oxygen inhalation
(in the dental workplace).
Usually the employer will have liability insurance to cover any injury that occurs on the
premises to either staff or visitors (e.g. patients and their accompanying people, contractors etc.).

Liability insurance: a type of insurance that protects against claims of negligence or
inappropriate action that were alleged to result in bodily injury (or property damage) to another
person.

Employees’ Responsibilities
All employees, including dental nurses, have a duty to take reasonable care of their own health
and safety. Therefore, you are required to:

• Work to agreed procedures in accordance with the instruction and training given
• Report any suspected health problem related to your work
• Not enter certain designated areas unless you are authorized to do so
• Be trained in the use of the specified materials or equipment
• Not interfere with or misuse any equipment or item that is meant for the purpose of controlling
or eliminating risk
• Report to your immediate supervisor or line manager, as a matter of urgency, any apparent
faults in procedures or equipment.

Risk Assessment
A risk assessment is simply a careful examination of what, in the workplace, could cause harm to
people. Doing a risk assessment helps employers decide whether they have taken enough
precautions, or should do more, to prevent harm from occurring to themselves, their staff or
others.

A risk assessment should:

• Identify a hazard
• Consider whether anyone (e.g. especially certain staff handling specialized equipment, older
people, pregnant women, children, etc.) may be harmed by that hazard
• Evaluate the existing precautions
• Take action to improve precautions and minimize the risk of the hazard occurring
• Record the findings
• Review regularly the arrangements – at least once a year.

Possible risks in your practice
Handling dangerous substances:
• Certain dental materials used in the dental surgery and laboratory (e.g. acids) that could cause
bodily harm if not used correctly
• Substances used for developing radiographs (X-ray films)
Handling dangerous instruments (these may also be dangerous if hot):
• Extraction forceps and other surgical instruments
• Handpieces and dental burs
• Orthodontic pliers
• Sharps – instruments, scalpels, needles
Handling dangerous machinery/equipment:
• Dental handpieces
• Electrosurgery equipment
• Heating equipment
• Laboratory equipment
• Lasers
Dental nursing is one of the safest occupations.

Generally, the risk of hazards occurring in the surgery are very low nowadays because of
regulation and enforcement of good work practices by government authorities such as the HSE.
Most dental staff are in good general health. The more important concerns in the dental
workplace are:

• Accidents
• Allergies
• Assaults
• Burns
• Chemicals
• Electrical
• Eye damage
• Fires and explosions
• Infections and inoculation injuries
• Lasers
• Noise
• Posture
• Pregnancy
• Pressure systems
• Radiation
• Stress.

Dental staff are commonly exposed to respiratory infections, mainly ‘colds’, and other viral
throat and chest (respiratory) infections. Other more serious respiratory hazards are ‘flu’
(influenza), tuberculosis (TB) and, to a much lesser extent, Legionella infection (also called
legionnaires’ disease). All these infections could also be transmitted to patients or others.

The main infectious hazard in the dental practice is contact with infected body fluids (blood,
saliva, etc.). Infections can be transmitted via sharps injuries (needlestick injury; inoculation,
particularly those caused by viruses such as hepatitis B, hepatitis C and human
immunodeficiency virus (HIV). Prions, which cause Creutzfeldt–Jakob disease (CJD), are
virtually impossible to destroy. MRSA (methicillin-resistant Staphylococcus aureus) infection is
mainly a healthcare-associated infection (HCAI).