Comment on “Occupational Exposure to Blood and Body Fluids in a Department of Oral Sciences: Results of a Thirteen-Year Surveillance Study”

Gatto and coworkers analyze dental care workers (DCW) injuries which occurred in the Department of Oral Sciences of the University of Bologna over a 13-year period, with the aim of assessing if additional safety precautions or modification of current procedures are needed. Their findings show that the device more frequently involved in accidents is the needle for local anaesthesia (41% of percutaneous injuries), disposable and nondisposable, and that students are those most frequently exposed (40%), especially during instruments reprocessing and disposal [1]. The authors conclude that " an adequate prevention could have avoided only eye injuries. " As our research group on occupational risk of infection with bloodborne pathogens (Studio Italiano Rischio Occupazionale da HIV e da altri patogeni a trasmissione ematica, SIROH) has collaborated in the development of the European Directive 2010/32/EU protecting healthcare workers from needle and sharps injuries [2], which will integrate Italian legislation on occupational risk in healthcare, we support additional safety precautions— included in the directive—for the prevention of occupational injuries in DCW. Indeed, in our opinion, in their analysis they fail to consider (1) including modifications in the protocol for using and disposing of carpules, for example, through a wider adoption of disposable devices, instead of using nondispos-able syringes, which clearly need additional manipulation for reprocessing, and (2) the implementation of devices incorporating a safety-engineered mechanism (safety-engineered devices (SED)), while available, within the possible preventive interventions. Both measures appear within the requirements of the European Directive, which supports an overall preventative strategy including safer procedures for the use and disposal of used sharps and the provision of SED where there is a risk of injury and contact with the patient's blood. A study in the United Kingdom (UK) is a good example of both measures [3]. The authors describe the steps in the introduction of a safety syringe replacing a nondisposable device into a UK dental school. These steps include, among others, the collection of evidence for the need for a change, the training of staff, and the feedback to the manufacturer on the new device. As for the need for a change, they considered all avoidable needlestick injuries which had occurred in their facilities over a 3-year period and identified those occurring at a dedicated clinic dealing exclusively with patients with bloodborne viruses (predominantly HIV) due to the use of nondisposable syringes and those occurring among staff at a dental school during recapping …