This study provides several insights into the patterns of incidents in a dental school setting over an 11-year period, during which there was a relocation to a new facility and a growth in the overall student and staff complement. The transition of the UQ SoD to the UQ Oral Health Centre in late 2014 meant that students and staff were working from January 2015 with completely different equipment in the simulation laboratories as well as in the clinics. At the same time, there was growth in the student cohort size and changes in its composition, with more international students joining progressively over time. Such factors could all contribute to changes in the nature of workplace incidents for staff and students.
It is not unexpected that the hands emerged as the most likely body part to sustain a non-sharp related injury, accounting for 19.4% of all incidents of this type. This result is consistent with other investigations, and highlights the hands-on nature of dentistry [10]. Changes in school policies regarding ergonomic practices and the use of magnifying loupes may influence this rate in the future, as will the use of different types of instruments and devices that alter the nature of manual manipulation in laboratory and clinical tasks. The progression of digital technologies in dentistry will also likely influence the situation for dental students in the future, as it changes the nature of preclinical learning activities.
The present results highlight the importance of protecting the face and head, since the head and neck region was the second most common site for an injury (12.9%). Examples were seen of situations where eye injuries occurred splashes of fluid, raising questions about protective eyewear for protection from projectiles, versus protective face shields for protection from splashes of fluids. The same aspect has also been highlighted in the COVID-19 pandemic. It is certain that attention will continue to centre around personal protective equipment (PPE) for the face and the eyes. In contrast to earlier studies, compliance with the use of PPE at the UQ SoD was high and in line with current guidelines [20]. There may be benefits for certain procedures where fluid splashes are likely to move to a full face-shield [21].
An interesting finding in the present study was how the annual number of incidents declined once the cohort of staff and students had settled into the new facility and become accustomed to operating its equipment. Dramatic changes in building design, including the flow of patients and students through public areas, and different layouts of the clinical areas and equipment can all contribute to changes in injury rates. In the design and planning process for the new dental school, there was a large emphasis on optimising ergonomics and workplace health and safety. These aspects influenced cabinetry design, the use of wall and ceiling mounted equipment, the type and positioning of dental chairs, and the types and locations of sharps containers.
Other workplace changes that can cause a marked change in injuries are to the processes involved in instrument recirculation, moving this more to an automated and mechanised system rather than a workflow driven by many manual steps. The mechanisation of instrument reprocessing at the UQ SoD in the mid 1990’s reduced the rates of sharps injuries sustained by dental assistants, as noted in the 1997 study of Macdonald et al. At this stage, cassettes had been introduced for instrument storage, reducing their handling, and instrument washers replaced manual cleaning of dental instruments [14]. The same principles are used at much greater scale in the new facility, which is greater in size and the number of dental chairs than the previous facility by over 60%. On that basis, with larger student cohorts and a greater staff complement, having lower annual incident rates in 2017–2019 than in 2010 indicates that real progress has been made over time.
Supporting this view, there were several types of injuries that occurred in 2010–2014 (before the dental school relocated) that disappeared from 2015, when the relocation was complete. These include knee injuries from the use of ‘knee-operated bins’, lacerations from serrated paper towel dispensers, and slips and falls on stairs. It can be concluded that the physical infrastructure of a dental school has a significant impact on non-sharp injuries. Attention to this aspect is important when planning new facilities, upgrading existing facilities, when acquiring new equipment and planning workflow, as it can ultimately prevent or eliminate certain types of injuries.
One of the well-established limitations of archival data is that they are often under-reported [10, 21], including for student dental facilities [6, 7]. Therefore, it is possible that the true incidence of non-sharps injuries at the UQ SoD may be higher than what is documented. Arguing against this, the UQ SoD leadership over the 11 years of the study and the clinical operations management team in particular have emphasised the need for accurate and timely incident reporting, and there is a strong culture of accident reporting within the school.
One consideration that was not examined in detail in this study was the influence of the level of experience of the staff member or the student, because the incident reports had been anonymised. It is likely that estimations of relative risk may reveal important effects of the student year level or the experience level of staff, relative to the complexity of the procedure being undertaken at the time of the accident. One would expect that more experienced clinical operators and support staff such as dental assistants would be less likely to sustain injuries as than novices to the particular workplace tasks [20]. Such aspects could be the focus for future studies.
In conclusion, in addition to improved education and training, facilities, equipment, work processes and safety protocols should therefore be reviewed regularly to minimise injuries that are recurring on accident reports. Appropriate personnel should regularly assess incident records in a retrospective manner to identify fundamental causes and basic trends, so that preventive measures can be put in place to protect all involved.