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Safer sharps in dentistry: clarification

The BDIA have written a clarification of some of the points to note in the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.

Information and guidance on the sharps regulations went out in May 2013.

Since then there has been some confusion regarding the interpretation of the regulations and the role of risk assessments in relation to the use of safer sharps.

The BDIA has taken the opportunity to raise the matter with the Health and Safety Executive (HSE).

To reiterate, from 11 May 2013 all dental practices have to ensure that they comply with The Health and Safety (Sharp Instruments in Healthcare) Regulations 2013 – this means that dental practices must avoid the unnecessary use of sharps.

BDIA points to note:

  • Under the regulations, where it is not possible to avoid the use of medical sharps, practices are required to use safer sharps (a safer sharp is defined as one that incorporates features or mechanisms to prevent or minimise the risk of accidental injury) wherever and whenever possible
  • The BDIA understands that it is the HSE’s intention that non-safe sharps are only used under ‘exceptional’ circumstances and that this is then subject to a comprehensive risk assessment by the employer/dutyholder
  • Recent discussions with the HSE reinforce the requirement for the widespread use of safer sharps
  • Based on BDIA discussions with the HSE, the employer/dutyholder must consider whether safer devices are reasonably practicable. The Health and Safety Executive (HSE) Health Services Information Sheet Seven available here covers the criteria that dutyholders/employers should consider
  • The HSE believes that for the majority of dental activities there may be safer devices available and that a risk assessment would deem them reasonably practicable to use
  • The HSE believes that it is only in limited cases (suggested by the HSE as those incurring significant costs or relating to individual patient comfort) traditional devices would still be used. Ultimately, it would be for a dentist to justify to the courts why they did not use a safety device. It would be very difficult for a court to agree with the dentist if there was a reasonable safety device on the market and others were using them
  • With regard to recapping, BDIA discussions with the HSE indicate that sharps should not be recapped and if, in limited cases only, there was recapping, this is where a specific risk assessment would be expected
  • In relation to needle recapping, the HSE guidelines state: ‘Prevent the recapping of needles – regulation 5(1)(c) – Injuries can occur after a needle has been used if the healthcare worker holds the needle in one hand and attempts to place a cap on the needle with the other hand (so-called two-handed recapping). Needles must not be recapped after use unless the employer’s risk assessment has identified that recapping is required to prevent a risk (eg to reduce the risk of contamination of sterile preparations). In these limited cases, appropriate devices to control the risk of injury to employees must be provided. For example, needle-blocks can be used to remove and hold the needle cap and so allow safe one-handed recapping’
  • In terms of needle block use in dentistry, these devices offer a relatively safe procedure where the dentist has used some of the anaesthetic in the cartridge and intends to make a further application on the same patient. The placing of the syringe assembly into a needle block and its removal is a one-handed operation. However, these devices are not generally appropriate for disassembly where there is a greater element of risk in the operation, requiring more sophisticated devices, such as those that shield the needlepoint from the operator during disassembly
  • The HSE also commented that technologies were constantly improving and manufacturers are making more safety devices. Therefore, if a dentist decided it was not reasonably practicable, this decision would require constant review to see if different or new products changed the reasonably practicable decision. 

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Let us just remind ourselves: Google BDIA and you get 'The BDIA represents and supports manufacturers and suppliers of dental products, services and technologies.' So no vested interest there then in selling us a more expensive solution to a problem we don't have. I suggest you do a risk assessment and act in a responsible way to the results. If you have needle stick injuries in your practice, you must do something to reduce the risk. If you don't; then what you are doing at the moment is controlling the risk. You must of course record any such risk assessment, any injuries and actions taken. You must protect your staff and yourselves and patients against transmission of blood borne viruses. I think you might find that sharps injuries if they still occur are more likely from matrix bands or tips left in handpieces than needles. Serbjit Kaur has confirmed to me that this legislation does NOT mean that you have to do something different and I quote: • ‘this Directive is not going to require practices to do anything different.’ • ‘Dentists do need to resheath needles, they will need to have a written policy which covers a risk assessment having taken place and identify protocols for safe resheathing if this required.’ • ‘This Directive will not mandate how resheathing should take place.’ I hope this clarifies the position.
I agree with Keith, my interpretation of the sharps regulations is that we have risk assessments in place, we don't have to suddenly switch to safety syringes. Resheathing by hand is not good practice at all but there are plenty of great safety devices out there. I also wonder how biased this report is...
I also concur with Keith's comments. Matrix bands, burs and ultrasonic tips left in handpieces (especially when stretching over handpiece brackets to get to the tray) injure the dentist. The DA is vulnerable mainly at the scrub sink (though the use of cassettes reduces the risk greatly) from potential injury from hand instruments and endodontic files to be reused. If resheathing needles, one-handed is the ONLY way to go and you do not need to buy any Resheathing Aids to achieve it safely. If you are not anywhere close to the pointy end, you won't get hurt.