Alcohol-Based Hand Rinses in Dental Offices

Q. Is it acceptable to use alcohol-based hand rinses in dental offices?

A. Yes, in fact, using waterless alcohol-based agents is now considered by the CDC to be the preferred method of skin asepsis. Most formulations contain emollients to soften skin and prevent dryness. Other benefits include rapid and effective antimicrobial action and increased hand asepsis compliance, as these products provide enhanced accessibility and convenience.

However, there are several limitations such as they can not be used if hands are visibly soiled and they should be stored away from high temperatures or flames. In addition, since hand softeners and glove powders may “build-up” on one’s hands, handwashing with soap and water may be needed after every 3-5 applications.

Work-Related Injuries

"Data collected through a National Electronic Injury Surveillance System occupational supplement (NEISS-Work) provide information on persons treated for nonfatal work-related injuries and illnesses in U.S. hospital emergency departments (EDs). CDC's National Institute for Occupational Safety and Health uses these data to monitor injury trends and aid prevention activities. This report summarizes 2004 NEISS-Work injury and illness surveillance data. In 2004, an estimated 3.4 million nonfatal ED-treated injuries and illnesses occurred among workers of all ages, with a rate of 2.5 cases per 100 full-time equivalent (FTE) workers aged >15 years.

More than three fourths of all nonfatal workplace injuries/illnesses were attributed to contact with objects or equipment (e.g., being struck by a falling tool or caught in machinery), bodily reaction or exertion (e.g., a sprain or strain), and falls. No substantial reduction was observed in the overall number and rate of ED-treated occupational injuries/illnesses during 1996—2004."

Ref. MMWR: April 27, 2007 / 56(16);393-397 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5616a3.htm?s_cid=mm5616a3_e%0A

Comment: Injuries (e.g. sharps injuries, work related musculoskeletal disorders, etc.) in dental personnel continue to occur at unacceptable rates. Your employees are your most valuable asset. Please contact Dynamic Dental Safety (888-669-8846, ext. 701) for information on our on-site training programs designed to help prevent dental work-related injuries and illnesses.

Safety issue........ hazardous materials

Note the picture at the left taken in a dental office a short while ago. There are multiple issues that can be seen as safety/OSHA or risk to dental professionals in the office.

The first of the issues that is noted is that the label on the container is not appropriate. Either a manufacturer's original label or an appropriate secondary container label (Dynamic Dental Safety can provide a customized specific label) should be evident on the container.

Next, and a slight bit less obvious is the fact that this bottle is resting on the floor. Should this item tip over, spill or leak in any way - the contamination of the underlying floor surface and cleanup would be extensive. A simple solution to this would be to place the container in a "boot tray" or other containment item. This would simplify the process of cleaning, thus saving time and expense for the dental office.

For solutions to this or other safety and risk areas relating to compliance in the dental office, please call Dynamic Dental Safety at (888) 669-8846 ext. 701

It's Not Too Late!!!!!!!!....the NPI time is here for dentists

The time is coming close for the implementation of the third part of the HIPAA regulation applicable to dental offices. The American Dental Association states the following:

Any health care provider who uses standard electronic transactions, like electronic claims, eligibility verifications, claims status inquiries, and claim attachments, will be required by federal law to start including NPIs on electronic transactions not later than May 23, 2007. In addition, those dentists who use only paper, voice and fax to transmit these communications may find NPIs useful or necessary for other reasons. Many dental plans will require dentists to include NPIs on paper claim submissions, so even paper based dentists may find it a necessity to have NPIs.

Thus, our recommendation is to apply for and implement this as soon as possible. Following this link to the ADA article will allow each and every dental professional and dental office to make application either online or via mail:

http://www.ada.org/prof/resources/topics/npi.asp

For assistance with this or any other compliance issue for the dental office, please contact us at Dynamic Dental Safety at (888) 669-8846 ext. 701

Show Your Infection Control Practices to Your Patients

The general public is becoming increasingly aware of infection control and other safety practices in healthcare. Newspapers, television and radio news carry daily stories on emerging pathogens, antibiotic resistant bacteria, foodborne poisoning, avian influenza, medical errors, etc. Your patients expect that your office is following "state-of-the-art" safety practices and are watching that you implement them consistently.

For example, we have heard about dental offices where a patient calls OSHA with a complaint that they observed their dentist not changing gloves and/or washing their hands before starting their procedure. When we investigate these complaints, we usually find that the dentist changed gloves and washed their hands in another operatory or sink area (i.e. not viewed by the patient). We recommend that you try to change gloves and wash your hands in front of your patient. By demonstrating good infection control practice, your patients will acknowledge that you consider their safety as number one!

How Do You Clean Utility Gloves?

Since utility gloves (i.e. heavy rubber gloves used when handling chemicals) are reusable, they may be decontaminated with 1:10 bleach or an EPA approved disinfectant. However, utility gloves should be inspected before and after use and discarded if they are cracked, peeling, torn, punctured, or exhibit other signs of deterioration or when their ability to function as a barrier is compromised.

Safe Usage of Dental Products

Just by viewing the container of Clorox wipes to the left in the dental office does not tell us the whole story. Exactly what do we mean by this?... well we must look for certain statements either on the container label or on the MSDS sheet if we have that available in the dental office.

First, in order to utilize an item for disinfection of countertops in the dental office (or cleaning any surface in the dental office that may be contaminated with bodily fluids) - that product must have the classification of being "tuberculocidal". In simple terms, it has been tested and is at the level required to disinfect the dental countertop and other non-porous materials at the appropriate level.

Additionally, we should be aware of the proper methods of addressing any injury from the chemicals within the product. One of the important items that we should be aware of and train our staff on is the use of the eyewash. An often overlooked item is placed right on the label of most products and that is the time of use to rinse our eyes if we are exposed to the chemical in the dental office.

As we can see the time listed on the right... the back of the label of the product.. tells us that we should rinse our eyes for 15-20 minutes. The importance of training our staff and additionally any "temporary" employees in both this as well as the location of the eyewash is essential in our dental office.

For help or clarification with this or any other dental compliance questions please contact us at Dynamic Dental Safety at (888) 669-8846 ext. 701

HIPAA Privacy Rules

Q. Can I still call out patients' names in the waiting room?

A. Yes, it is OK to call out the patient’s full name. For example… it is fine for the receptionist to announce in the waiting room, "Mary Jones, we are ready for your now". However…"John Smith, your dentures are ready is inappropriate". Thus, under HIPAA Privacy Rules, it is acceptable to call out a patients name, but not combined with particulars such as the reason for their visit. In addition, please be careful about the vollume of your voice when discussing a patient in the office, whether it be on the phone, in an operatory or corridor.

Exit Signage

One of the items that often goes overlooked in the dental facility at the expense of items like the MSDS, infection control, and other much more difficult issues to comply with is the signage issue for exits. We typically see either the wrong size of signage at the dental office just due to the fact that we do not pay this item much attention.

Note that the sign at the right is illuminated... this is not a requirement if there is enough ambient lighting along the exit route in the dental office. However, the size of the lettering is strictly regulated by OSHA. Our guidance to the dental office is to research and implement all applicable standards to ensure the optimum compliance with OSHA.

The link for the signage size standard is:

http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=INTERPRETATIONS&p_id=19456

For additional information on this topic or any compliance questions please call Dynamic Dental Safety at (888) 669-8846 ext. 701

OSHA Hazard Communication and Chemical Labels

Q. What do the numbers and symbols on an NFPA fire diamond mean?

A. Under the OSHA Hazard Communication Standard, chemical containers are required “to communicate” the specific hazards of the chemical to the employee. Interpretation of the National Fire Protection Association (NFPA) diamonds: Blue = Health Hazard; Red = Flammability; Yellow = Instability; White = Special Hazards. Numbers in the three colored sections range from 0 (least severe hazard) to 4 (most severe hazard). The fourth (white) section is left blank and is used only to denote special fire fighting measures/hazards. For example, the “3” in the blue diamond communicates that short exposure of the chemical could cause serious temporary or residual injury even though prompt medical attention was given. For a specific chemical, one should consult the Material Safety Data Sheet (MSDS) to determine the appropriate hazard ratings which go into each of the diamonds.

The OSHA Hazard Communication Standard requires dental offices to: have a written plan (e.g. comprehensive manual); properly labeled chemicals; Material Safety Data Sheets readily available; and training provided to all employees who handle hazardous chemicals in the office.

Please contact Dynamic Dental Safety for all of your Hazard Communication needs: (888) 669 – 8846 ext. 701.

Do Not Over-Fill Sharps Containers

Sharps containers are specially designed containers into which used needles and other dental-waste sharps are discarded. In recent years, models have been introduced which are intended to prevent users from overfilling the container. However, most containers we presently see in dental offices simply have a visible “do not fill over line” which is usually set at ¾ of the container's volume. It is imperative that dental personnel do not overfill containers.

Sharps injuries associated with disposal containers are among the most serious kind, as you are not able to identify the source patient. This means that as part of the medical evaluation, the conservative approach is to consider that you have been exposed to all of the most common bloodborne pathogens – HIV, hepatitis B and hepatitis C.

Ergonomic Risk Factors in Dental Offices

Q. What factors contribute to Work-Related Musculoskeletal Disorders (WMSDs) in the dental office?

A. WMSDs in dental personnel is a significant issue, that does not get enough attention in terms of prevention efforts. Ergonomic stressors include, but are not limited to:

• Repetitive motions (e.g., scaling, polishing)
• Awkward and static neck, back and shoulder postures
• Poor or improper adjustment of equipment
• Infrequent breaks

The April issue of The Dental Safety Compliance Newsletter will feature an article on dental ergonomics by a leading expert, Bethany Valachi, MS, PT, CEAS. She is president of Posturedontics, a company that provides research-based dental ergonomic education (www.posturedontics.com). You can sign up for our complimentary Newsletter in the Web Form in the right column of this Blog Page.

Dental Emergency Plan…………. Why????

In our visits and consultation with dental offices throughout the country, it is amazing how few have planned for that ultimate contingency… an emergency of any sort. Certainly, we counsel the dental office in forms of preparedness with respect to the HIPAA Security dictates. Additionally we prepare the dental office with respect to how to evacuate the premises and a gathering location for that limited emergency. These are not only important, they are requirements under OSHA.

Our Department of Homeland Security has produced an excellent document addressing many if not all of the issues of “protecting our business” as well as our employees and patients. This can be found by following this link:

http://www.ready.gov/business/_downloads/readybusiness-brochure.pdf

We encourage each and every dental office to implement and drill on emergency preparedness to ensure the safety of all.

For any further information or help with this or any other compliance issue please contact Dynamic Dental Safety at (888) 669-8846 ext. 701

Use the Right Glove for the Appropriate Task

A common mistake found in dental offices is when staff use latex or vinyl exam gloves for virtually all tasks. Heavy rubber gloves, also known as utility gloves should be used when cleaning and disinfecting instruments, surrounding surfaces and operatories. In general utility gloves made of nitrile, butyl, or neoprene are protective for most chemicals used in the dental office. However, it is good practice to check the MSDS of the specific chemical you are handling for specifications on the type of gloves that would be protective. A utility glove should be worn if the MSDS states a waterproof or protective glove is required.

Orthodontic Wires

Should the orthodontic wire used in a dental office be disposed of as regulated medical waste? This is a question that is posed to us in virtually every orthodontic office. The answer to this question is delivered by OSHA in a response that dates back to 1990........ and the answer is yes as seen in this link:

http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=INTERPRETATIONS&p_id=19998

Further, as a means of risk prevention in the office, it is advised to all of our clients that any and all orthodontic wires should be disposed of in a certified sharps container.

For any questions regarding this or any other compliance questions please contact Dynamic Dental Safety at (888) 669-8846 ext. 701

Where can you get a Material Safety Data Sheet?

Under the Hazard Communication Standard, OSHA requires you to have an accessible MSDS Sheet for all hazardous chemicals in your dental office. When you buy a chemical, the manufacturer is required to provide a copy of the MSDS. If it is not included in the same package with the chemical, you can contact the manufacturer and ask them to fax or mail the MSDS to you. In addition, some companies have MSDS’s for their products on-line and you can easily access them and print them out.

Dynamic Dental Safety’s OSHA/Risk Management CD Rom includes over 1,000 MSDSs on commonly used dental chemicals and products. For additional information, please contact Dynamic Dental Safety at: ( 888) 69-8846 ext. 701.

Glutaraldehyde Use in the Dental Office

Glutaraldehyde is a toxic chemical that is used as a cold sterilant to disinfect and clean heat-sensitive medical, surgical and dental equipment. Health effects of glutaraldeyde exposure include:

• Short term (acute) effects: skin and eye, nose, throat and respiratory track irritation.
• Long-term (chronic) effects: Glutaraldehyde is a sensitizer. Workers may get sudden asthma attacks with difficult breathing, wheezing, coughing, and tightness in the chest. Prolonged exposure can cause a skin allergy and chronic eczema, and afterwards, exposure to small amounts produces severe itching and skin rashes. It has been implicated as a possible cause of occupational asthma.

Although you can limit exposure to glutaraldehyde through work practice, engineering controls and personal protective equipment, the best consideration is changing to safer product substitutes. Please contact Dynamic Dental Safety (tel. 888-669-8846 x701) for manufacturer contact information.

References: 1) Best Practices for the Safe Use of Glutaraldehyde in Health Care. OSHA Publication 3258, (2006), 48 pages. 2) OSHA Hospital eTool: Healthcare Wide Hazards Module: Glutaraldehyde

Dental Safety Glasses

Dental personnel are occupationally exposed to ocular hazards when using rotary instruments and handling chemicals. Eye protection is essential to reduce exposure to bloodborne pathogens, chemicals, particulates and radiation. Dental safety glasses and shields must fulfill a wide range of functional and ergonomic aspects. In addition, they must comply with OSHA and ANSI Standards.

Most dental professionals want safety glasses that not only give good eye protection, but provide good vision and are easy to wear and use. For a complimentary form that may be used to help you evaluate safety glasses, please contact Dynamic Dental Safety at: (888) 669 – 8846 ext. 701.

Confidentiality of Printed Patient Schedules

Q: Does HIPAA regulate where printed patient schedules are placed in the dental office?

A: Yes. Some offices may print out the patient schedule for the day and post it for professional staff. Often the schedule is posted where it can be seen by a patient - either in the examining room, or in a corridor, or on a door. Where it is placed may result in an unauthorized disclosure of patient information. Offices must make an effort to protect identifiable personal health information on a schedule of appointments, but this does not mean that the use of patient schedules is prohibited. If a schedule is placed in an operatory, with the patient’s back to the wall where it is hung, this would likely be considered sufficient protection of patient information.

Another approach is to place the printed side of the schedule facing the wall. Then one has to simply turn the bottom of the page up to reveal the schedule. An office that shows it has made a conscious effort to protect such information by placing it in a location accessible to professional staff, but with minimum access by patients in the office, will not be in violation of the HIPAA privacy rule to use printed patient schedules.

Ref. California Dental Association

No Eating or Drinking in Dental Clinical Areas

According to the OSHA Bloodborne Pathogen Standard 1910.1030(d)(2)(ix), eating, drinking, smoking, applying cosmetics or lip balm, and handling contact lenses are prohibited in work areas where there is a reasonable likelihood of occupational exposure. During our on-site safety surveys, we have noted that staff often drink beverages in clinical areas such as the operatories or lab. Although it may be difficult, drinking and eating should be limited to such areas as the break room, offices or other non-clinical areas.

Is this sterile??????

In many of our trainings and talks with dental offices, the assumption is that when the dental assistant, dental hygienist, or the dentist sees the packet at the left......... it is sterile. This is quite common since the color has darkened at the arrows. Unfortunately, this is not a correct assumption!!!!

With virtually all of our sterilizers in the dental office that utilize a combination of steam and pressure to effect the sterilization of our instruments...... only one of those parameters is measured with the color change on the packet or the tape. This most often is that the chemical changes color when the temperature has risen to the correct level and stayed at that heat level for the proper amount of time.

The true measure of the correct operation of the sterilizer is that of a spore test. There are multiple ways to measure this both in the dental office and outsourced to a separate testing facility. According the the CDC, they state the following under the recommendations for Sterilization:
6. Monitor sterilizers at least weekly by using a biological indicator with a matching control (i.e., biological indicator and control from same lot number) (IB)

Feel free to contact us at (888) 669-8846 ext 701 for any further information regarding this or other compliance issues.

Boodborne Pathogen Training

Q. Does OSHA require annual bloodborne pathogen training for dental personnel?

A. Yes, annual training is required for all personnel who have occupational exposure to blood or other potentially infectious materials (OPIM). Training should include an explanation or description of the following elements:

• An explanation of 29 CFR 1910.1030, Occupational Exposure to Bloodborne Pathogens.


• The activity's exposure control plan and instructions for how to obtain a written copy of the plan.


• The basic epidemiology, modes of transmission, and symptoms of bloodborne diseases.


• The criteria for the recognition of tasks and other activities in which occupational exposure may occur.


• The methods that prevent or minimize occupational exposure [i.e., engineering controls, work practice controls, personal protective equipment (PPE)] and their limitations.


• The selection criteria for PPE and the criteria for equipment availability, use, handling, decontamination, and disposal.


• The hepatitis B vaccine to include its benefits, efficiency, safety, administration, and availability.


• The procedures for reporting exposure incidents and the availability of medical treatment and follow-up examinations.


• The procedures for reporting and cleaning up spills.


• An explanation of the warning signs, labels, and color-coding systems used.

Dynamic Dental Safety offers on-site training with approved contact hours. For additional information, please call: (888) 669-8846 ext 701.

What's underneath your Operatory Sink?

As storage in many dental offices is at a premium, staff store items anywhere they can…underneath the sink is a favorite spot. Since water from pipe condensation or leaks can contaminate supplies, clean and sterile patient care items should not be stored underneath sinks. Dark and damp areas are a favorite place for insects and vermin. Consider this… would you want exam gloves, tooth brushes, mouthwash and other dental supplies which have been stored under the sink used in your mouth? Note that it is acceptable to store a few chemicals such as cleaners and disinfectants underneath the sink, but not a fire extinguisher as shown in the picture.