Dental Tribune U.S. Edition

Practice Matters DENTAL TRIBUNE | OctOber 20118A The Occupational Safety and Health Administration (OSHA) is an organization of the federal govern- ment that ensures proper compli- ance with current workplace health and safety regulations. OSHA will likely be ramping up its inspections of dental offices in the upcoming months. In order to be prepared, dentists should be aware of OSHA’s updated program and what they should be doing now so they have the best possible outcome in case of inspection. ‘Be prepared’ The best way to handle an OSHA inspection is to be prepared. It is important to have all paperwork current, all materials in proper order and established policies and procedures to ensure dental office safety. Below are some general rec- ommendations from OSHA and the Centers for Disease Control and Pre- vention (CDC) that, if followed, can reduce dentists’ exposure to liability in event of an OSHA inspection. OSHA manual First, ensure that the dental office has an OSHA manual on hand and that everyone working in the office is aware of its location and the information contained within. To be up-to-date, the OSHA manual should have a current exposure con- trol plan, a current hazard commu- nication plan and documentation of annual training as required by OSHA’s Bloodborne Pathogens Stan- dard. The dental office should also have a well-kept record of informa- tion regarding how waste is han- dled and disposed of in the office, the plan of what to do in case of an exposure incident, how to pro- cess instruments and all schedules and procedures for equipment and office disinfection and cleaning. The exposure incident plan should be as detailed as possible, including infor- mation such as whom to report an incident to, where to go for testing, what procedures should be followed and what documentation should be completed. Standard precautions Ensure that the dental office is fol- lowing standard precautions. This includes treating all body fluids as potentially infectious. As such, any item that could be potentially contaminated should be treated as infectious, including all instruments, surfaces and patients. To properly protect from exposure to infectious contaminants, employees should be provided with and be compelled to use personal protective equipment when handling anything that could be potentially contaminated. Also, ensure that all dental office employees are following the prop- er dress code procedures, which should include wearing jackets with long sleeves, gloves, masks and eye protection whenever per- forming a duty that could possibly expose them to infectious materi- als. In addition, if exposure is more likely than normal, extra precaution should be taken. In those instances, employees should wear an impervi- ous gown instead of a jacket. These dress items should be properly maintained and cleaned and should be replaced when needed. Training Ensure that all dental office employ- ees are receiving the proper training in compliance with OSHA’s Blood- borne Pathogens Standard and the CDC’s 2003 dental infection con- trol guidelines. This training must be completed when the employee is first hired to work in the den- tal office. At this time, the new employee should also have a TB test to rule out active tuberculosis infec- tion. Moreover, any dental office employees who may be exposed to potentially infectious materials dur- ing employment at the dental office must receive a hepatitis vaccination immediately. If they were previously vaccinated, they must offer proof of such vaccination immediately. Along those same lines, den- tists should complete an annual TB risk assessment to ensure the dental office is still considered a low-risk environment. This paper- work should then be filed in the OSHA notebook kept in the office. Medical records for every employ- ee of the dental office should be properly maintained. These records must be kept separate from other OSHA materials in order to comply with privacy laws. These employ- ee records should contain all rel- evant health information, including evidence of HEP B immunization and other immunizations, and any results of testing following an expo- sure incident. Engineering and work practice controls Engineering and work practice con- trols should also be used in the dental office to reduce the like- lihood of exposure to potentially infectious materials. These controls will isolate the dentist from hazards. These controls include using thick gloves when handling instruments and placing the appropriate items directly into sharps containers, nee- dle recapping devices and ultrasonic baskets. Instruments should also be handled very carefully when used in order to prevent injury. The same instruments should be processed carefully so that they receive proper sterilization. Instruments should be carried to the sterilization area on a closed tray to prevent injury during transport. Sterilization areas should be arranged so that there are com- pletely separate areas for clean and dirty instruments in order to pre- vent the possibility of cross con- tamination. If an item is heat sensi- tive, ensure that the manufacturer’s recommendation for disinfection is being followed. An annual evalu- ation of devices with sharps safety features should be performed. If no such devices are used in the dental office, you are required to document why a specific device that does not contain the available safety features was chosen for use. Also, ensure that all instruments are being cleaned before steriliza- tion. The preferable method for cleaning instruments is with an ultrasonic because hand contact is minimized. If an ultrasonic is used, the ultrasonic solution should be changed every day and at any time the solution becomes too thick. All instruments should then be wrapped or bagged with a heat sensitive indi- cator placed on both the inside and outside of the package. This ensures that the instruments are reaching the correct heat and pressure levels for proper sterilization. Once sterilized, the instruments should be put in closed drawers or cabinets in the office so that the packaging remains properly closed. The sterilizers should be tested at least once a week with biological indicators to ensure they are work- ing appropriately. Make sure all waterlines are being properly maintained. This is essential to ensure that all water that goes into a patient’s mouth is drinking water quality at minimum. Furthermore, make certain that all clinical surfaces, walls, floors, sinks and the like are being kept clean and sanitary. To ensure proper cleaning is taking place, a cleaning schedule must be established, with the proper cleaning frequency for the type of surface and degree of contamina- tion made clear. Make sure the dental office has a working eyewash station in a clean sink. Moreover, the office should have a proper fire evacuation plan that is prominently posted and that every office employee is aware of. The office itself should be kept in a neat, sanitary and clean condition at all times, with exits clearly marked. OSHA controls contaminated waste while inside the dental office. In most cases, only sharps, and blood and saliva saturated materials are considered hazardous materi- als, which must be disposed of in a certain, regulated manner. When in the office, contaminated waste items must be placed in contain- ers that are prominently labeled with a “biohazard” label. Employees must always wear personal pro- tective equipment when handling these items. When chemicals are outside of their original containers, they must be properly labeled at all times. There should be a current chemi- cal inventory, which includes cor- responding MSDS forms, located in the dental office. Nitrous and oxy- gen tanks must be secured and reg- ularly inspected to ensure they are working correctly, and this should be noted in a record kept within the office. If you have questions about the required compliance, there are some great OSHA and CDC publica- tions. In addition, you can obtain checklists and other useful resourc- es from organizations such as the American Dental Association and the Organization for Safety, Asepsis and Prevention. DT By Stuart Oberman, Esq. Is your office in compliance with OSHA regulations? About the author Stuart J. Oberman, Esq., has extensive experience in repre- senting dentists during dental partnership agreements, part- nership buy-ins, dental MSOs, commercial leasing, entity for- mation (professional corpora- tions, limited liability compa- nies), real estate transactions, employment law, dental board defense, estate planning, and other business transactions that a dentist will face during his or her career. For questions or comments regarding this article, visit www.gadentalattorney.com.