Exposure control practices for administering nitrous oxide: a survey of dentists, dental hygienists and dental assistants

Details

• Personal Author:
  Boiano, James M. ; Steege, Andrea L. ; Sweeney, Marie H.
• Description:
  Engineering, administrative, and work practice controls have been recommended for many years to minimize exposure to nitrous oxide during dental procedures. To better understand the extent to which these exposure controls are used, the NIOSH Health and Safety Practices Survey of Healthcare Workers was conducted among members of professional practice organizations representing dentists, dental hygienists and dental assistants. The anonymous, modular, web-based survey was completed by 284 dental professionals in private practice who administered nitrous oxide to adult and/or pediatric patients in the seven days prior to the survey. Use of primary engineering controls [i.e., nasal scavenging mask and/or local exhaust ventilation (LEV) near the patient's mouth] was nearly universal, reported by 93% and 96% of respondents who administered to adult (A) and pediatric (P) patients, respectively. However, adherence to other recommended precautionary practices were lacking to varying degrees, and were essentially no different among those administering nitrous oxide to adult or pediatric patients. Examples of work practices which increase exposure risk, expressed as percent of respondents, included: not checking nitrous oxide equipment for leaks (41% A; 48% P); starting nitrous oxide gas flow before delivery mask or airway mask was applied to patient (13% A; 12% P); and not turning off nitrous oxide gas flow before turning off oxygen flow to the patient (8% A; 7% P). Absence of standard procedures to minimize worker exposure to nitrous oxide (13% of all respondents) and not being trained on safe handling and administration of nitrous oxide (3%) were examples of breaches of administrative controls which may also increase exposure risk. Successful management of nitrous oxide emissions should include properly fitted nasal scavenging masks, supplemental LEV (when nitrous oxide levels cannot be adequately controlled using nasal masks alone), adequate general ventilation, regular inspection of nitrous oxide delivery and scavenging equipment for leaks, availability of standard procedures to minimize exposure, periodic training, ambient air and exposure monitoring, and medical surveillance. [Description provided by NIOSH]
• Subjects:
  Anesthesia Dental Offices Engineering Nitrous Oxide Occupational Health Safety
• Keywords:
  Author Keywords: Nitrous Oxide Control Methods Dental Anesthesia Providers Dentists Engineering Controls Exposure Controls Nitrous Oxide Safety Practices Web Survey
• ISSN:
  1545-9624
• Document Type:
  Text
• Genre:
  Journal Article
• Place as Subject:
  Ohio ; OSHA Region 5
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  DSHEFS - Division of Surveillance, Hazard Evaluations, and Field Studies
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  409-416
• Volume:
  14
• Issue:
  6
• NIOSHTIC Number:
  nn:20049027
• Citation:
  J Occup Environ Hyg 2017 Jun; 14(6):409-416
• Contact Point Address:
  Jim Boiano, MS, CIH, National Institute for Occupational Safety and Health, Division of Surveillance, Hazard Evaluations and Field Studies, 1090 Tusculum Ave., MS R-17, Cincinnati, OH 45226-1998
• Email:
  jboiano@cdc.gov
• CAS Registry Number:
  Nitrous oxide (CAS RN 10024-97-2)
• Federal Fiscal Year:
  2017
• NORA Priority Area:
  Healthcare and Social Assistance
• Peer Reviewed:
  True
• Source Full Name:
  Journal of Occupational and Environmental Hygiene
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:dda6b82795ab799776e38ff2a33077bebff60b236f17b6b6109ec51f541c34a3f17623400611c425c854b067185a1618ecfd03e32f5108e9146ae9830eb9e6d3
• Download URL:
  https://stacks.cdc.gov/view/cdc/203618/cdc_203618_DS1.pdf
• File Type:
  [PDF - 666.68 KB ]