Why would a dental practice require an eye wash station? Is it required by law? And if so, what type of equipment is needed?
Although the Royal College of Dental Surgeons of Ontario recommends the installation of eye wash stations in dental offices (Infection Prevention and Control in the Dental Office, 2010), there is still some confusion about whether they are actually required. This guideline, along with provincial legislation and product safety data sheets, detail why every dental practice is required to install an accessible eye wash station(s). What key features are required to ensure the station is safe and effective is found in the American National Standards Institute (ANSI) standard Z358.1-2014 (“Emergency Eyewash and Shower Equipment”) as well as manufacturer instructions.
Provincial safety legislation is enacted to assure that workers are provided with safe and healthy workplaces. These laws authorize the adoption of complementary safety standards and regulations to fulfill the mandate of improving worker safety. With requirements and guidelines coming from what seems like every direction, it becomes clear that every dental practice requires an eyewash station(s).
Why Have an Eye Wash Station?
The legal requirement for eye wash stations is found in most provincial and federal health and safety legislations. For instance, Ontario’s Occupational Health and Safety Act, Industrial Regulation 851, states:
“Where a worker is exposed to a potential hazard of injury to the eye due to contact with a biological or chemical substance, an eyewash fountain shall be provided.”
Further, the “General Duty Clause” for employers to exercise due diligence and “take every precaution reasonable in the circumstances for the protection of a worker” applies anywhere that an occupational risk of eye injury could be said to exist.
Do dental offices fall into this category? It’s clear that they do. While provincial safety regulations do not specifically mention dental offices, dental practices use a variety of chemicals and corrosive materials, putting both personnel and patients at risk of suffering eye injuries. Substances such as bleach, hydrogen peroxide, phosphoric acid, formocreosol, methyl methacrylate, varnish and more, are potentially hazardous to the eyes. Accidental chemical exposures can occur even with safety precautions and with the use of personal protective equipment.
The first 10-15 seconds after exposure to a hazardous or corrosive substance are critical. Eyewash stations provide on-the-spot decontamination. While you hope you will never need to use one, having an eyewash station installed could save a person’s vision.
That’s why the Royal College of Dental Surgeons of Ontario advises:
“The conjunctival mucosa of OHCWs [oral health care workers] should be protected from spatter and debris created during dental procedures by wearing appropriate eyewear or face shields… It is also recommended that an eye-wash station should be available in the dental office for both OHCWs and patients to aid in managing contact with any bodily fluid or dental chemical/solvent.”
Proper Use of Eye Wash Stations
The biggest error people make when using eye washes is not flushing long enough. Holding the eyes open while streams of water flood them is uncomfortable, even when the eye has not been injured, and even five minutes can seem like a long time. However, many chemicals require flushing times of 15 minutes or more (up to an hour for penetrating corrosives) to ensure further damage to the eye is minimized. It is also important not to leave the victim unattended as they may need assistance in maintaining the bent-over pose while flushing the eyes.
Safety Data Sheets (SDSs) must be easily accessible, so that appropriate first aid can be quickly given. The first priority is to flush the eye immediately. Once the person is set up at the eye wash station, the SDS should be consulted to determine recommended flushing time. Follow-up medical attention, of course, is essential.
Specifications for Eye Wash Stations
As yet, there is no specific provincial or Canadian standard for the design and placement of eye wash stations nor are there plans to develop a Canadian standard. This is because in Canada, we follow the American National Standards Institute (ANSI) standard Z358.1-2014 (“Emergency Eyewash and Shower Equipment). The ANSI standard is used as the authoritative, comprehensive and current guideline. Let’s look at some of the key requirements specified in the ANSI standard.
Location
The eyewash stations(s) must be located in areas that are easily accessible (no doors or other barriers to access) within ten seconds (roughly 55 feet). Imagine a person blinded by burning chemicals, stumbling towards the station. That person must not be at risk of colliding with someone’s desk or tripping over steps. The station should be identified with a highly visible sign that contains an easy-to-recognize symbol that does not require workers to have English reading skills to understand it.
Water Delivery
The unit should be designed so that it:
- activates within one second or less
- flushes both eyes simultaneously
- provides hands-free operation (so the hands can be used to hold the eyes open)
- delivers a minimum of 15 minutes of copious flushing
- has protective covers on the nozzles (to prevent contamination) that are self-removing when flow is started
- delivers tepid water (16 – 38º C, see discussion below)
- delivers adequate volume of water (at least 1.5 litres/minute; or 11.4 litres/minute for a combination eye/face wash station). However, the water force must not be so strong that it could drive contaminants into the optic system or otherwise injure the eye.
Why Tepid Water?
Water that is too hot (over 38º C) is harmful to the eyes and can actually enhance the action of harmful chemicals on the tissue. Cold water, previously deemed acceptable, is not ideal either. It can cause hypothermia, and because it is much more uncomfortable than tepid water, leads to inadequate flushing times. In fact, ANSI further defines tepid water as “a flushing temperature conducive to promoting a minimum 15 minute irrigation period.” When longer rinsing times—up to 60 minutes—are required, tepid water can make the difference between the treatment being tolerable for the required length of time, or not.
Obviously, it’s essential that users not have to waste time adjusting the water temperature or risk injury to the eye due to temperature extremes such as scalding. Tepid water can be delivered to eye wash stations by different means, the most common being thermostatic mixing valves or water tempering valves. These valves effectively blend hot and cold water to provide a comfortable flushing fluid within the temperature range recommended by ANSI.
Maintenance and Other Considerations
The ANSI standard also covers:
- shut-off valves: If shut-off valves are installed, there must be a device in place to secure them against accidental/unauthorized shut-off.
- waste disposal: Flushing fluid may be contaminated and so proper disposal provisions must be in place.
- proper maintenance and weekly testing: Carelessly maintained equipment may fail to perform properly when required or even contaminate the user’s eyes. Weekly testing ensures equipment is operating correctly and also helps clear the supply lines of sediment and bacteria build-up that is caused from stagnant water. It’s best to assign one person to perform weekly testing and to keep a signed, dated record of inspection.
What About Eyewash Bottles?
Eyewash bottles and other personal eyewash units are useful to allow quick flushing of small particles or contaminants, or to immediately rinse the eye before going to the eyewash station. However, as the above guidelines should make clear, they is no substitute for a full eyewash station. Bottles cannot provide the full 15 minutes (or more) of flushing that may be required, and it is difficult (or impossible, depending on the product) to flush both eyes at once.
Training
Safety equipment, of course, can only do its job if people know how to use it. All workers require instruction in the proper use of eyewash stations before any emergencies occur. Instructions should be made available to all workers and posted beside the eyewash station. Contact lens removal should be included in the training, as immediate removal of contact lenses is important to prevent chemicals trapped under the lens from causing injury. The instructional process should include a “hands on” drill with workers demonstrating correct use.
WHMIS training is the other important component in eye safety. Staff must be familiar with the various hazardous substances used in the practice and their safe handling, as well as the location of the SDSs and how to quickly find the First Aid instructions on the sheet.
It only takes a few seconds to permanently injure an eye. Considering the range of hazardous chemicals used in today’s dental practices, and the potential for particles to be projected at high speed during dental procedures, eye wash stations should be considered standard equipment for every practice—and there is little doubt that provincial safety inspectors will draw the same conclusion. Installing proper eye wash equipment protects everyone involved: staff, patients, and the dentists/practice owners themselves.
Resources
The Canadian Centre for Occupational Health and Safety’s OSH Answers Fact Sheet: Emergency Showers and Eyewash Stations can be read/downloaded here:
https://www.ccohs.ca/oshanswers/safety_haz/emer_showers.html
The full ANSI standard may be purchased online here:
http://webstore.ansi.org/RecordDetail.aspx?sku=ANSI%2fISEA+Z358.1-2014
About the Author
Lauren McFarlane, BA, CHSC
President of Dental Practice Safety
A trainer, coach, visionary and consultant who is a leader in the field of Occupational Health and Safety (OHS). Lauren is a certified Consultant and Board Member (Toronto chapter) with the Canadian Society of Safety Engineering (CSSE) and has earned a long list of OHS certifications and training. The creation of the Dental Practice Safety Club demonstrates another benchmark achievement for Ms. McFarlane and another first within the safety and dental communities.
