Infection Prevention
Take action to comply with OSHA standards
Prior to 1992, OSHA regulations specific to bloodborne pathogens didn’t exist, and employees in dental practices had little recourse if they felt they were at risk of occupational exposure. As a direct result of employees’ concern over a lack of protection provided by some employers, the OSHA Bloodborne Pathogens Rule emerged.
According to the Organization for Safety, Asepsis and Prevention (OSAP), during the mid-1990s, when the case of the Florida dentist who infected six patients with HIV became national news, there was public outcry (and subsequent legislation) to require certain precautions be taken to prevent disease transmission. Patient awareness and fear of infection, along with the late 1980s uncertainty about the exact modes of HIV transmission, drove dental professionals to adopt universal precautions and begin considering all blood and certain body fluids as potentially harboring bloodborne viruses. Later, these expanded into standard precautions, which encompass all body fluids (with the exception of sweat) and all infectious diseases—not just bloodborne viruses.
“This changed the standard of care, and dental professionals who did not adopt these changes exposed themselves to potential liability if a patient or employee contracted or suspected they contracted an illness in the dental office,” explains the nonprofit association. “For the last five years, major infection prevention groups have refined their emphases, including a shift from the term ‘infection control’ to ‘infection prevention.’ Control indicates a reduction in numbers of cases, while prevention means elimination—‘zero tolerance.’”
The liabilities and risks that dentists face regarding infection control for both staff and patients extend beyond financial ramifications. For infection control lapses involving patients, there is the possible violation of state dental board regulations, which can result in fines and license suspensions for serious violations. For infection control lapses involving employees, there is the risk of OSHA violations, which also carry fines and penalties. In addition, civil liabilities can occur when an illness, or the serious risk of illness, to either patients or employees occurs. Lawsuits have resulted from issues involving needlesticks, dental unit waterlines, improper sterilization, etc.
“Ambulatory healthcare, including dentistry, is currently a center of attention for infection prevention in the United States. One article reported more than 30 major infection prevention breaches in ambulatory centers during the last 10 years,” OSAP says. “A few cases have been so significant in scale and egregious behavior that several states are considering making infection prevention malfeasants not just a tort issue, but also a criminal violation.”
To avoid infection control risks and liabilities, OSAP emphasizes that knowledge and communication are the best defenses. Dentists who ensure both they and their staff are aware of the Centers for Disease Control and Prevention guidelines, and state and federal regulations, are acting in a responsible manner. Regular training in infection control for all personnel, including the dentist, should be documented. Attendance as a team at such infection control CE courses as the OSAP Annual Infection Prevention Symposium should be followed by discussions in a staff meeting about what was learned in the course.
“All staff members must be aware of their facility’s infection prevention program. Progressive offices make it a point to actively involve office personnel (including input) in their facilities’ programs, often through regular office meetings,” OSAP emphasizes. “Patients must be aware of the activities performed by the office. Communication about infection prevention between office and patients, and among office personnel, is essential.”
Source: DiMatteo A. Infection control: falling short is risky business. Inside Dentistry. March 2012. https://www.dentalaegis.com/id/2012/03/infection-control. Accessed May 4, 2012.
OSHA Standards for Dentistry
OSHA has developed a page for dentistry on its Web site, https://www.osha.gov/SLTC/dentistry/index.html. There are currently no specific OSHA Standards or Directives for dentistry. However, exposure to numerous biological, chemical, environmental, physical, and psychological workplace hazards that may apply to dentistry are addressed in specific standards for general industry. This Web site provides links to those standards as well as references related to OSHA enforcement policy such as directives and interpretation letters. Some states have OSHA-approved State Plans and have adopted their own standards and enforcement policies.
Inspections
The OSH Act authorizes OSHA to conduct workplace inspections to enforce its standards. Workplace inspections and investigations are conducted by OSHA compliance safety and health officers who are professionally trained in the disciplines of safety and industrial hygiene.
There are steps that can be taken to prepare for an unexpected visit from an OSHA inspector. These steps include:
• Join the Organization for Safety and Asepsis Procedures (OSAP; www.OSAP.org; 800-298-6727). OSAP is a nonprofit organization dedicated to helping dental professionals with their infection control and occupational safety and health needs. It offers training materials, answers to technical questions, a comprehensive Web site, and much more.
• Making sure the required OSHA poster, Job Safety & Health Protection (www.osha.gov/Publications/osha3165.pdf), is displayed in an area accessible to all employees.
• Identify, make available, and review all OSHA standards that apply to the workplace.
• Ensure that all the required written programs, documents, and employee records are current.
• Audit safety and health compliance in-house.
• Designate a workplace compliance officer.
• Identify the persons that need to be present if there is an OSHA inspection.
• Make sure that employee training concerning OSHA standards is current, recorded, and correct.
• Regularly review employee records required by OSHA.
• Designate activities for all employees in the case of inspection.
The two most common forms of citations given to dental offices and clinics involve the Bloodborne Pathogens and Hazard Communication Standards. It is always best to be proactive. Communicating safety and health information and proper employee training are keys to success. Offices and clinics in which there is good communication and increased interest in health and safety reduce their chances of an OSHA inspection.
Source: Palenik CJ. Complying with OSHA standards. Inside Dentistry. June 2006. https://www.dentalaegis.com/id/2006/06/complying-with-osha-standards. Accessed May 4, 2012.
