Professional Insurance Programs

How to Prevent Bloodborne Pathogen Injuries in Dentistry

By Nan Dreves, RDH, MBA, Professional Health Horizons, nkdreves@gmail.com

Every effort should be made to minimize risk and prevent accidents in a dental setting. There is a risk of transmission of hepatitis B, hepatitis C or HIV infection percutaneous or mucocutaneous exposure. The deeper the exposure(s) or volume, the greater the risk of transmission.

OSHA states in the bloodborne pathogen standard 1910.1030(f)(l)(ii)(D) that post-exposure management and medical follow-up be “provided according to recommendations of the U.S. Public Health Service.”

Here are some commonsense ways to reduce your chance of injury:

  1. Focus on the procedure, take your time, do not rush or be distracted.
  2. Look before reaching for instruments. Do one task at a time.
  3. When placing instruments on a tray, ensure they are in the appropriate place and a single layer. When returning a used instrument to the tray, do not stack them. Return them carefully; do not throw them.
  4. Collect all necessary instruments before treatment starts. Ensure they are transported in a covered, puncture-resistant container to avoid the chance of injury from dropping or bumping into someone.
  5. Do not recap local anesthetic needles with two hands. Use a recapping device or one-handed scoop technique.
  6. Always recap the needle before changing the cartridge or needle.
  7. Clinician should uncap, administer injection(s), and safely recaps before changing the needle or cartridge. Do not pass an uncapped needle to an assistant.
  8. Burs in handpieces should be removed immediately after completing treatment. Another idea is to place a clean inverted plastic cup over the burs.
  9. When placing items in the sharps box – be cautious, unhurried, and deliberate. Sharps boxes should not be behind a cupboard door or in a drawer. It must be readily accessible.
  10. Obtain self-sheathing or safety needles. Examples: SecurInject, 1SHOT™ Safety Syringe, Ultra Safety Plus XL®.
  11. Use heavy-duty utility gloves when handling sharps.
  12. Written needlestick prevention protocols, accident prevention education, reporting of exposure incidents, and critical thinking.


Every dental healthcare setting must determine where follow-up care for an injury would occur for both the source patient and the dental healthcare worker. The post-exposure testing for HBV, HCV, and HIV (both antigen and antibody) can be refused by either party. When a dental injury occurs, we must explain to the medical provider how it happened and why it is considered a significant exposure. Their knowledge of our instrumentation and procedures is limited, and although some injuries do not involve blood, saliva alone is an infectious body fluid.

Your family, friends, and loved ones appreciate the attention to our well-being. Remember, safety, like kindness, matters!



  • ADA Dos and Don’ts for The Safe Handling of Instruments and Sharps
  • 2016 CDC Infection Prevention & Control Guidelines & Recommendations
  • CDC’s Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care


If your office needs an Incident Report Form, email Nan at nkdreves@gmail.com.