The Compliance Divas Podcast
Our podcast covers current topics such as infection prevention and control, OSHA and HIPAA compliance for dentistry. We discuss the latest regulatory information, answer frequently asked questions and give suggestions for dental practices to make compliance easy and sustainable. The Compliance Divas are a trusted source for consistent, accurate information based upon current guidelines, standards, science, and recommendations.
The Compliance Divas Podcast
#233 How to Handle a Needlestick without Panicking
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Above all, when a needlestick happens, don't panic and don't squeeze the injury. A needlestick injury is a potential exposure to bloodborne pathogens and knowing the proper steps to follow is key. Tune in as the Divas walk you though the proper steps so you'll be prepared and not panicked if an incident occurs.
- Bloodborne Pathogens Standard 29 CFR 1910.1030(f): https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.1030/
- OSHA Bloodborne Pathogens Standard Exposure Incidents https://www.osha.gov/sites/default/files/publications/bbfact04.pdf
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Welcome. I'm Leslie Cannon. I'm Mary Gavoni. I'm Linda Harvey.
SPEAKER_00I'm Olivia Juan, and together we are the Compliance Divas.
SPEAKER_02Welcome to the Compliance Divas podcast. This is Linda Harvey, and I will be your moderator for this episode. Today we're going to address how to handle a needle stick. This is something that might seem mundane or easy to take care of in a practice because you know you have a policy or procedure, but oftentimes we find that panic sets in when you stick yourself or an incident happens. It always happens at the most inopportune time. And remembering off the top of your head what you should do is not always easy. So Diva says we get started on our topic today, how to handle a needle stick. Mary, could you lead us off with the first step, please?
SPEAKER_01Linda, I totally agree with what you said about panic setting in. And it does, even though we may think we have a good needle stick protocol, when it does happen, it sort of goes out the window. So we just want to review the important procedures. Number one thing to do is um first of all clarify what a needle stick is. It is not a poker puncture with a sterile needle that we haven't injected with, or the hub end of the needle as we're putting it on a syringe, loading a syringe. It is a contaminated needle. So either perhaps during recapping or when you're removing it from a syringe and you poke yourself with the hub end. So the first thing you do is you take your glove off and you wash the area with soap and water. Don't squeeze the wound. And I remember my grandmother always talking about that. Yeah, milk it, get all the bad stuff out. But the problem is when you let go of the squeeze, any microorganisms or contaminants may actually get drawn further into the tissue than they initially were. So clean it with soap and water, and then you probably have some kind of a either disinfectant wipe that's suitable for skin, or the best thing is probably alcohol, which you no doubt have in your treatment areas because of using it on um composite materials and instruments to clean them off. And alcohol is a good skin antiseptic. So soap and water, then some kind of a skin disinfectant.
SPEAKER_02Mary, that's a great first step for our listeners to remember. And I really like how you draw attention to why we shouldn't squeeze the wound. That's the first thing that everybody thinks about, and actually it's counterintuitive. So thank you for bringing that to light. Leslie, what would somebody do next if they have a needle stick? How would they go? How would they proceed?
SPEAKER_00Well, once they have provided first aid for themselves, then immediately notify your either your employer or supervisor or whoever is actually set in your practice as the OSHA coordinator because immediate action has to take place. So there's a protocol that we want to uh initiate. And the OSHA requires that the employer provide this written protocol with step-by-step plan on how to uh access healthcare and and uh how to go forward with some of the other documentation and questioning the patient, that sort of thing, which we'll get to in a minute. But the main thing I wanted to really focus on is that immediate reporting. Sometimes people are embarrassed to report that they had an accident, particularly new employees. And you want to look your best, you want to perform your best, and uh every dental office should onboard new employees with the steps to take for an exposure incident. OSHA requires that, but uh everyone should know that you're not going to get fired for having an accident. You might get fired for trying to hide an accident and not reporting it. I remember I had one dental office contact me uh about a week after an accident took place. Their dental assistant had poked himself when he was working in the sterilization room, um, removing instruments from the ultrasonic tank. And he didn't want to report it because he didn't want to seem like he wasn't capable or efficient. And he um kept it secret until his finger started to hurt. And he decided, well, I better say something because it now it's really hurting. So he got some kind of an infection from it, but he didn't mention it at the time it happened, where they could have initiated their action plan. Because the truth of the matter is when you have an exposure incident, you're not the healthcare provider anymore. Now you're the patient, you're the victim, and your day has changed. So report the incident immediately to your employer or supervisor, and then let them put the emergency action plan into place, which is going to take care of all of the rest of the steps, including expediting medical care or at least the offer of medical care in front of a healthcare professional, if it is warranted. And certainly I would want to have everyone see a healthcare provider, no matter how minor you think your exposure incident end. And just a quick little side story. My dad is a dentist, and when he was a general dentist, he had a hygienist that poked herself with a contaminated instrument. They looked at it together and they thought, well, she's done some first aid. This looks like a little nothing. It turned out to be something big. She got a staph infection from her uh instrument poke, and it was from the staph bacteria on her own skin. So it's not necessarily that we're looking for hepatitis or HIV. It there could be other reasons why a healthcare professional should evaluate this exposure incident. Now, OSHA does allow uh employees to decline medical evaluation, but the employers have to know that they need to offer that medical evaluation to be able to expedite whatever post-exposure prophylaxis might be warranted. And it might not be, again, hepatitis or HIV. It might be prescribing an antibiotic or an antibiotic skin regime or a soaking in beta dine or something like that. Now we don't know what a prescription is going to be from a healthcare provider unless they have a chance to take a look at it.
SPEAKER_02Thank you, Leslie. I really liked how you drew attention to the fact that now if you have a needle stick, you move from being the clinician, whether you're a dental assistant, hygienist, dentist, surgical tech, surgery assistant tech, sterilization tech, whoever, right? But so you move to being the patient now. So we have to have a different mindset because it does disrupt your day, as Mary said. You have to move quickly, and there is urgency behind this just to seek media attention. So please be sure you do notify whoever your hierarchy is, whether you're in a private practice, a group setting, or a larger DSL. Know who you report your incidents to. Thank you, Leslie. So, Mary, that brings us to step number three. And can you talk to us a little bit about the source patient and how to how we handle this?
SPEAKER_01Absolutely. So, one of the things that we need to do in this process is identify who the source patient is for the injury. In other words, if you are injecting on a patient or you're recapping a needle used on that patient, then you need to let that patient know there's been an incident, and OSHA requires that you ask that patient, that source patient, if you know who it is, to be tested for hepatitis B, hepatitis C, and HIV. Now that patient doesn't have to agree to be tested, but you should document that on your incident report form. But it also might be that you don't know who the source patient is. An example of that might be I'm the sterilization tech and I've got a stack of trays that I'm breaking down to get my instruments reprocessed, and I'm disassembling a syringe, or maybe I poke myself with a contaminated instrument, and I don't necessarily know whose instruments those patients or which patient those instruments were used on. So you are not required in that instance to go to every single patient that was treated in that time period to ask them all to go be tested. Um, but you simply document that the source patient is unknown. But that's a really important thing. Um I would say that it is incumbent on the practice if the patient agrees to go and be tested, that it is paid for by the practice. And in some situations, not all, but some situations it's actually paid for by the workers' compensation company, um, the insurance policy, as is the testing for the employee. So there's a lot of factors there that you should talk to your workers' compensation um carrier to find out what their provisions are and so forth, and have a protocol that you discuss ahead of time as to who's going to ask the patient. And I think this is best handled by the doctor, that the doctor sits down eye to eye with the patient and says, we've had an incident. Um, we just need to let you know that our employee's been injured, or maybe it's the doctor himself or herself. And I'm required to ask if you'll go for testing, we'll take care of the cost of it. It's confidential. We just need to know if you have hepatitis B, C, or HIV in order to potentially treat our employee who may have been exposed. So practice that ahead of time because that's not necessarily a comfortable conversation or a typical conversation that you would have with a patient.
SPEAKER_02Mary, I love how you drew attention to the fact that that conversation is not comfortable and it's not a typical conversation that we have. So being prepared is very important. And I always liken it to other plans for preparation that we have in the practice, whether it's emergency medical plans, what are we going to do if the patient has a medical incident, what do we do if there's a fire, all the medical, all the plans that we have. This is a plan that needs to be implemented and planned and practice, like you said, Mary. So thank you very much. So Leslie, that brings us to step four. And let's talk about the injured worker and the medical uh evaluation here she needs to have.
SPEAKER_00Well, Linda, time is of the essence. When a needle stick or incident occurs, uh, if the patient does have, let's say, uh HIV, there's post-exposure prophylaxis that can be administered. And uh it's more effective if it's administered promptly rather than uh several days later. So immediate evaluation, not at the end of the appointment, not at the end of the day, not at the end of the week, but I mean now pencils down, like they used to say in school, you know, stop your test, immediately now time out and get in front of a healthcare provider to determine, again, the employee's risk for exposure to hepatitis or HIV. Um if the patient agreed to have the blood test uh didn't know their status, that would be ideal that that patient is seen at the same healthcare facility so that it can ease the concerns and the anxiety of the exposed employee that they have not been exposed to a patient who has hepatitis or HIV. And if the patient was uh diagnosed through testing as having hepatitis or HIV, the post-exposing uh post-exposure prophylaxis could be initiated immediately. In some cases, we don't we have a patient that either declines medical evaluation uh or um has stated that they they know that they've never been infected with hepatitis or HIV. And so the employee goes to the healthcare provider and they two together will make a decision as to whether they want to embark on the post-exposure prophylaxis path or not. And remember, Linda, that the only vaccine-presentable bloodborne pathogen is hepatitis B, if someone has had their hepatitis B vaccination and the efficacy, uh the studies show that the vaccination provides immunity for at least 28 years. So uh speaking with a healthcare provider, if you've had your hepatitis B vaccination uh longer than 28 years would be an important thing to go over as well. And the other part about what Mary was talking about was on asking the patient their status, that's a hard thing to do. Because you think about it, the patient has filled out a health history form, and that's always going to have hepatitis or HIV. And would the patient feel like, well, if I say that I was diagnosed with that, am I, am I going to be considered a liar, you know, on my health history form? And is are they gonna be mad at me? Well, you know, if we flip that around and say for a moment, you know, patients don't know us when they come for their first visit. They don't know how well they can trust us. With HIPAA, of course, we wouldn't violate their privacy and and discuss their health issues, or if we've had good infection control training, we're not gonna be concerned if someone has had hepatitis or HIV uh in the past. But patients don't know that. They don't know how they're gonna be treated if they put that information on the form for the get-go. Now, of course, after they've been our patient for a while, they certainly do know us and trust us. But uh there's got to be a delicate way of asking the patient how if they know their status without making them feel that they weren't truthful before. And uh I recommend a script that is reviewed annually, just like your exposure incident protocol is supposed to be an annual review that you talk together with your team about what the doctor might say, how that might sound. You know, Mrs. Jones, my assistant Leslie just got poked with an instrument that had some of your blood on it. By law, following all OSHA regulations, I need to ask you a few questions about your health. Would that be okay, Mrs. Jones? And and yeah, the patient will certainly say yes, and that's where the conversation could open up about uh have you ever been diagnosed or have you, since you last filled out your health form, been diagnosed with hepatitis or HIV? And then when it comes to the point about a patient doesn't, hasn't ever had a diagnosis and they don't know their status, would you be willing to have a blood test to determine whether there's anything in your blood that could cause infection for our assistant? Because if there is, there are medications that can prevent infection transmission. However, they have to be administered promptly to be effective. So, you know, something along those lines. And then also because so many team members work independently when a doctor's not in the office, many hygienists patients, again, of course, according to their dental board uh allows them with their duties and settings, they may be seeing patients without a doctor present, or an assistant may be cleaning up at the end of the day before they go home and the doctor's already left. So, would would a team member also feel comfortable having that conversation? So, again, you know, preparing, having the script in mind, just like with CPR. We know CPR. We don't have to pull out our CPR card and say, you know, how many breaths and how many compressions. We know it by muscle memory. A script on how to ask the patient uh regarding their status and whether they would be willing to be tested should also be something that we have pretty much top of mind.
SPEAKER_02Let's say thank you for those added points. I think it's it's important one that that the injured team member understands that they do need prompt medical attention because should they need the prophylactic medication, the ideal window of time is between two and 72 hours to start the medication. So to know sooner than later is important. And Mary, would you like to add as well?
SPEAKER_01Absolutely. And another approach, which may make it less uncomfortable in um asking the patient is simply asking the question, would you agree to be tested? Because that's what the bloodborne pathogen standard says. We don't need to ask them necessarily, have you ever been or are you HIV positive? Is there anything we need to know? So simply by asking them, would you agree to be tested, then may spark their response. Oh, yeah, I I know I have hepatitis B, I just didn't put it on my health history. So it's a little less maybe threatening to the patient, but you know, it again, as Leslie said, practice it, have a script, know what you're gonna say. But the other part of that is too making sure that you've set up ahead of time a place for these employees to go and the patients to go for testing. And it shouldn't be their family doctor, their primary care physician, because they may not be able to do rapid HIV testing, they not be may not be well versed in post-exposure protocol and prophylaxis, which by the way has changed. The US Public Health Service recently issued an updated guideline for post-exposure prophylaxis. We'll put that link in the show notes. Um, and so that you can actually triage with that facility to know whether you need to send that patient for testing, and can you send the employee and and so forth um immediately for that? So we need to plan ahead, as Leslie said.
SPEAKER_02Leslie Mary, thank you so much for addressing that gray area because I think that's where offices kind of have issues. How do we handle the source patient? What do we say? What do we do? And bringing attention to the fact that we need to have that plan in place. I think that's really an important thing to bear in mind. And it's important because one, as you mentioned, Mary, you may not be permitted to go to your private, your personal, your primary care physician or a general physician, because depending on the workers' comp laws in your state, you have to follow those laws. And some states you can, in some states, like Florida, you can't. You have to go within the workers' comp network. So knowing where to be seen is really important because as soon as your personal physician checks the box on the claim form that says it's work-related, your insurance is going to deny it if you're not supposed to be a your primary care doctor, you're supposed to be someplace else. And another way that I typically will say that is um help us be compliant. And I think sometimes, you know, that the patients help us be compliant. Would you consider being tested? Help us follow the rules and laws, you know how we work so diligently to be safe in our practice. And and Leslie, would you have a follow-up comment as well?
SPEAKER_00Yeah, you know, Linda, I wanted to uh first of all let our listeners know that we're gonna provide a checklist in the show notes on what to do step by step by step so that they have the information right in front of them and can review that. And I would encourage them to take it from the show notes, print it out, maybe put it in a plastic sleeve or laminate it, and put that in their sterilization room. So you have a step-by-step protocol. I also wanted to quickly comment that I love uh Mary's communication skills on how she moved that to uh may we ask you, and and uh rather than putting a patient on the spot. I had never considered that communication scale. I'm gonna change all of my documents to include that. And and then I also wanted to make sure that everyone understands that um, you know, there may be different uh rules in your state surrounding, if you have your own state OSHA plan. When I lecture outside of California, I check with OSHA in the state where I'm lecturing, and I ask for the department that would handle dental office uh uh audits or inspections. And one of the things that I love to ask the person at OSHA, the industrial hygienist that does the inspections, is um what's the number one thing that you cite dental offices for? And of course, needle sticks and and sharps containers always are way up there at the top. But another thing that actually was of interest to me is that the office did not have an exposure incident protocol, that they didn't have a step-by-step plan, and they didn't have listed where the employee goes for medical evaluation. That was very important to the OSHA uh industrial hygienist that I spoke with. He said, I just didn't see any direction as to where a team member would go for medical assistance if they needed it outside of the dental practice.
SPEAKER_02Thank you, Leslie. I think, Mary, what else would you like to add to this? With a lot of good information.
SPEAKER_01There is. And one additional factor that may weigh in here is what does your state dental board rules um say, or what do they say about exposure incidents and or your state department of public health? Because some states may require patients to be tested if we know who a source patient is. And so there may be a state law that says that that person is compelled to go for testing. So make sure that you know what your state dental board rules say and your public health rules say.
SPEAKER_02Well, Divas, I'm so glad we spent some extra time talking about this particular step on handling the injured worker as well as the finesse that it takes to handle the source patient and where to go to get tested, and how to develop that plan and what to say to the patients. I'd like to wrap up this step. Steps with the last two as being documentation. We know documentation, documentation, documentation. First is the incident report, which would be filled out by the injured team member. This should be there should be a copy in your OSHA binder, whether it's a hard copy or whether you keep those digitally, or maybe you have a quick go-to file when incidents occur. You can grab that document. Fill that out as quickly as possible. That gets filed in the employee's OSHA medical file. It does not get filed within your OSHA binder. That's considered confidential. Even though, as close-knit as everybody is on a dental team, and we we refer to ourselves as our dental family, everybody in the office will probably know you had this needle stick. It still is confidential and it needs to go into your OSHA medical file that is most likely managed by the office manager or maybe the dentist him or herself. Next is documenting the injury on your Sharps injury log. That's something that is maintained within your OSHA binder. And it's an anonymous listing of the incident itself, describing where it occurred, how it occurred, what instrument or what struck the employee. So that way you can track and trend incidents throughout the year to determine if there's anything that needs to be any opportunities for improvement, we'll say, for safer devices that aren't implemented, or maybe training on safer devices that have been implemented but aren't being used correctly. So those are the last two things. So to recap our steps was as Mary started us off with is first aid, take care of yourself and the injury first. Leslie made us aware of the fact that the urgency of reporting to someone is important. Don't wait and go home and think about it and come back over the weekend because it makes it harder to ask the source patient at that time because the longer the time span occurs, now we have a situation where we're asking over the phone versus sitting down eye to eye with the patient. And I would also add that if your patient has been sedated, oral sedation, IV sedation, that patient cannot legally give consent to go get tested. You can certainly have a conversation with them depending on how awake and alert they are, and then follow up the next day. Then the next was identifying that source patient and how we're required to ask the patient to be tested under federal law. And it's also important to understand what your state OSHA law may say or dental board may say regarding the mandatory requirement for that patient to follow through and be tested. Then Leslie reminded us about the medical evaluation. We spent a great deal of time talking about that for both the employee and the patient. And then lastly, with the documentation aspects. So we hope this episode has lent some or shed some light on how to handle a needle stick in your practice because certainly there's we don't want panic to set in. We want to have that calm, clarity in place so you're prepared if there's an incident. Well, thank you for joining us for this episode of the Compliance Divas. We bring clarity and simplicity to compliance to help you navigate the regulatory world. We invite you to subscribe to our podcast through your favorite podcast channel or on our website, thecompliancedevas.com. And we always welcome your questions, so please submit them to support at thecompliancedeevas.com. And even better, we'd love for you to scroll down and leave us a like or review or even pop a question in the show notes area. And you will find all the checklists and things that we've recommended and talked about during the training in the show notes as well. So, as Leslie recommended, download the checklist, laminate it, put it in a sleeve, and save it in your practice. So this let's make 2026 a safe year.