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Moving the Needle to Safe Dentistry

Categories: Healthcare-associated infections, Injection Safety

John O’Keefe, BDentSc, MDentSc, MBA

John O’Keefe, BDentSc, MDentSc, MBA

Guest Author – John O’Keefe, BDentSc, MDentSc, MBA
Board Chairman,
Organization for Safety, Asepsis and Prevention (OSAP)

Because safe injection and sharps management practices are central to dentistry, the One & Only Campaign resonates strongly in the dental care sector. That is why the Organization for Safety Asepsis & Prevention (OSAP), the dental sector’s premier organization dedicated to infection prevention and control, is joining the Campaign as a Member. We whole-heartedly support the Campaign and pledge to spread its messages to our members. We are also eager to share information on how we in the dental care sector promote safe injection practices with the healthcare community at large.

It was through my own personal experience in 1984 that I really learned about the importance of safe injection practices and how they relate to creating the safest dental visit possible. I had joined a practice where I was replacing another dentist who had left to set up his own practice elsewhere. I quickly learned that for months this dentist had been taking partially-used local anesthetic carpules from the old practice and re-using them in his new office. I was shocked by this behavior, especially when “one needle, only one time” thinking was already so ingrained in dentistry with regard to local anesthetic practices.

Coincidentally, since 1984, OSAP has been making sense of emerging infection control guidance and regulations, giving practical advice, and providing education to professionals in our sector. While we know that OSAP’s work has had great influence in promoting safe dentistry, it was disappointing to us last year that unsafe practices in an oral surgeon’s office led to the first documented report of patient-to-patient transmission of hepatitis C in a U.S. dental setting.

OSAP knows that work remains to be done to promote safe injection practices, and with the One & Only Campaign, we are happy not to be alone.

Public Comments

Comments listed below are posted by individuals not associated with CDC, unless otherwise stated. These comments do not represent the official views of CDC, and CDC does not guarantee that any information posted by individuals on this blog is correct, and disclaims any liability for any loss or damage resulting from reliance on any such information. Read more about our comment policy ».

  1. November 13, 2014 at 6:56 am ET  -   John TZOUTZAS

    Thank you John for the warning instructions related to the needles in Dentistry. After so many years of practice it is always a cutting edge issue , trying to minimize accidents and possible involvement in health threatening experience.

    Prof . John TZOUTZAS
    Infection Control and waste management committee
    Univ. of Athens . School of Dentistry

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  2. October 11, 2014 at 11:53 am ET  -   DrMI Scarlett

    Healthcare-Associated Infections (HAIs) are a key “Winnable Battle” for CDC. Last year, the Oklahoma department of health reported a key loss in the battle, when it reported an oral surgeon linked to patient to patient transmission of Hepatitis C. This case provides clear evidence that patient safety should dictate inclusion of dental practices in sentinel surveillance of outpatient health care facilities to assure progress on “Winnable Battles” in HAIs.

    As a 17 year veteran of CDC, including five years in oral health and more than 12 years working on HIV/AIDS, we knew that the largest outbreaks of hepatitis B were among ungloved oral surgeons in the mid-1980s, prior to the advent of available vaccines. To adhere to the ADA Code of Ethics to first do no harm, we dental professionals should consider the best ways to collaborate on a plan to assess how to include dental facilities in current surveillance systems in outpatient care facilities. New, and emerging infections, dictate vigilance, and how to assure patient safety in dental practice is our professional and ethical obligation.

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  3. October 2, 2014 at 12:11 pm ET  -   Dave Deeley

    As always John, your message was spot on and the thought that ANY Dentist would risk harming a patient in any way should NEVER be happening.

    OSAP will be even better than it has been with your guidance. REMEMBER THE FRAME

    Dave Deeley

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  4. September 18, 2014 at 3:19 pm ET  -   Sara Welsh

    My daughter had to have a baby root canal done, and she was terrified of the dentist using needles. Our dentist was very patient and kind to her while she was freaking out. Eventually, we got her calmed down and the injection was completed without incident. It’s amazing how gentle dentist can be now with the new technology and new techniques.

    Sara Welsh | http://www.nocavitybug.com/treatment.html

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  5. September 5, 2014 at 5:40 pm ET  -   Deborah Smith

    One of the safest practices a DDS can adopt is to stop trying to transfer a just used anesthetic syringe back to the dental assistant. Re-cap it yourself please! Dr O’Keefe please remind your colleagues of this.

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  6. August 28, 2014 at 6:33 am ET  -   Kendall Greenaway

    Thank you Dr. O’Keefe.

    ….. For ringing this bell today. Someone has to keep ringing this bell. Dentistry in our country excluded, modern professions have Standards of Practice that frame the core behaviour of the practitioner. “To be a member of our profession these are the rules and to do otherwise is a breach of professional conduct that is punishable by our order and quite possibly the law” ….. Simple standards, rules, a code.

    Not so in dentistry in North America. We are so afraid of offending individual liberty, that Dentists live with NO RULES. Ahh we laud the CDC for the Guidelines that dentists turn to to find out what they “should” be doing, but this is not a Standard or Code of Conduct, not even Best Practices. Best Practices are optional here. And how many dentists even know where to go to refer to these “guidelines”? There are a myriad of local quassia standards, of hygienists, or state and provincial authority that also embellish the word “should”.

    OSAP stokes the fires of Best Practices by bringing well intentioned and knowledgable professionals, like yourself, into a forum that encourages other like-minded engaged professionals to put the patient first. This group encourages behaviour that should be code, but sadly is not. That is why you are spending your valuable time so very gently and ever so politely prodding the masses of dentists in the right direction. Not good enough. The masses could care less unless there is a Standand of practice where the word “should” does not appear. They are not tuned in to your channel.

    Until Standards happens, the good intentioned experts and professionals that show up at the annual OSAP venue, or on the OSAP website, are not doing much at all to move the profession to Best or Standards Of Practice. Sadly, you are folks that know what Best Practices might look like, and you get together to share the good feeling, but as a group you are not getting to where the profession “should” have been 50 years ago, in the interest of the patient.

    Dentists are long overdue for a professional standard of practice that would be the word, defensible, defendable, and Best Practice in dentistry. We could make life real easy and start by accepting the UK Standard as a benchmark minimum. Hey, why reinvent the rules… Patients would scream if they knew what we “should” doing if the profession was really patient centric.

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  7. August 27, 2014 at 10:19 pm ET  -   Liliana Donatelli

    Congratulations Dr O’Keefe!
    This issue is very important. Thank you for your wonderful job as the chairman of OSAP, this amazing organization for infection prevention in dentistry.

    Because safety matters!

    Liliana Donatelli _ Brazil

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  8. August 27, 2014 at 9:36 pm ET  -   Cheryllynn Smith

    I have been working in the Nursing industry for 43 years and have followed some doctors that haven’t learned to use proper protocols affiliated with specific procedures. Aren’t Dentists also Doctors? As a nurse,we are taught sterile procedures. Why aren’t Doctors.. They are, so why don’t they follow this protocol? LAZINESS!

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  9. August 27, 2014 at 5:59 pm ET  -   Brian Kucey

    John:
    Tell me this story of the partially used carpules was not in Canada!

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  10. August 27, 2014 at 4:08 pm ET  -   Juanita from California

    Practicing below the standard of care for that almighty dollar, at the expense of people’s lives it is so terribly sad. It is horrific to think that that this still goes on, in this day and age of cutting edge technology. My prayers go out to all the patients and their families who have been affected by this. Jes RDH, HAP

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  11. August 27, 2014 at 12:38 pm ET  -   Gisela Ramirez

    Are dentists and dental technicians suppose to wash hands after removing the non sterile pair of gloves from a prior patient before putting on the new non sterile pair of gloves for the next patient? As a reired RN this practice concerns me very much.

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