Last month saw the EU Directive of 2010 pass into UK law as the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013. This new UK legislation requires healthcare professionals to assess the risk; and control it. For many it will mean a change not only to their habits but also to the equipment they use in order to comply. So are the risks really worthy of the new legislation and how easy will it be to adapt to within your practice?
Until it happens to you, the threat of infection with blood-borne viruses such as Hepatitis B, Hepatitis C and HIV carried by a patient may not be at the forefront of your mind. You might even assume that HIV is becoming less prevalent, however a report by the Health Protection Agency in 2012 revealed that the number of people living with HIV in the UK actually increased by an estimated 4,500 (from 91,500 to 95,000) from the previous year and that 24 per cent of that total were unaware of their infection. While important progress is being made in reducing the incidence of AIDS through antiretroviral therapies, HIV remains a very serious infection with high treatment and care costs and significant mortality.
Unless you can be certain that your patient is not infected with a blood-borne virus, sustaining a needlestick injury can be an alarming experience. Having effective protocols in place to enable staff to act quickly and effectively is essential.
David Jones, head of claims and underwriting at Dentists’ Provident, is currently overseeing at least half a dozen income protection claims where members have contracted HIV. The risk of contracting HIV from a needlestick is estimated to be 0.01 per cent and although the narrow bore needle is far less risky than a wide-bore phlebotomy needle, why would you want to take the risk?
“We’ve had a number of dentists tell our team that they have recently had a needlestick injury, but haven’t followed the protocols, which includes having a blood test. It’s vital to have a blood test as soon as possible after the injury so that the risk of transmission can be assessed, particularly if the patient is not sure of their blood status. If a degree of risk can be demonstrated following a needlestick injury you may need to start medication straight away. Get down to your nearest Accident and Emergency (or Occupational Health Service), ideally asking the patient to go with you, and get an independent assessment. If HIV is a potential threat, antiretrovirals need to be administered as quickly as possible to increase their effectiveness.”
Besides the risk to your health, exposure to blood-borne viruses can have a major and immediate impact on your career. Current regulations state that any dentist diagnosed with HIV must immediately cease practising dentistry leaving him or her without an income, in spite of many years of training and in some cases extensive experience. Without income protection, the financial impact could be devastating.
David continued “We have members who are currently unable to do clinical work because of their HIV infection, and have had to find alternative employment both inside and outside of the dental industry. We are supporting these members with proportionate payments of sickness benefits, due to the lower income they are now receiving because they are unable to work as a dentist.”
The regulations regarding practising in the UK with HIV infection are under review by the Department of Health and are expected to be revised later this year (July has been suggested). As a result of extensive lobbying of the Government and a comparison with the policies of other countries, a relaxation of the regulations to allow HIV Positive dentists to practise again under certain conditions may be brought about. For example, dentists in France can continue to practise if they are clinically well and have had an undetectable viral load for at least three months, while in the USA certain states allow dentists to practise, provided they follow infection control procedures. In 2012, the British Dental Association backed the conclusions and recommendations of a working group consultation on HIV-infected healthcare workers, highlighting its agreement with the fact that those who were infected were far more likely to come forward and reveal their HIV status, if they felt it would not automatically mean the loss of their livelihood and career. However, restrictions and strict monitoring of such professionals will inevitably continue whatever the outcome of this review.
Any measures that can be put in place to protect patients, as well as dental care professionals, from potential transmission of blood-borne viruses are to be welcomed. The new UK regulations from the Health and Safety Executive have focused on reducing the risk through the use of ‘safer sharps’, or ‘medical sharps that incorporate features or mechanisms to prevent or minimise the risk of accidental injury’. Needles must not be recapped after use ‘unless a risk assessment has been conducted and objectively concludes that recapping is required to control a risk’.
The guidelines specifically refer to the fact that a range of syringes and needles are now available with a shield or cover that slides or pivots to cover the needle after use. Septodont’s Ultra Safety Plus is one such device that has been clinically researched and was proven to reduce needlestick injuries from an average of 11.8 to zero per 1m hours worked.
“Dental needles are different to most other medical needles because they are double ended,” explains Mike Cann, Septodont’s managing director. “This means that if you recap the point, you still have exposure to the reverse end (which punctures the cartridge diaphragm). Both ends could potentially be contaminated since the act of aspiration draws blood back through the needle canula and into the cartridge. That’s why it makes sense to use a device with a sheath that locks into position while you dispose of it and avoids the need for potentially dangerous recapping.”
Bringing your practice up to date to comply with the new HSE regulations may mean making some changes to both your equipment and your methods. If it also means avoiding that seemingly inconsequential ‘scratch’ and safeguards your health and your career, it’s surely a price worth paying.