#151 I Wonder if OSHA Would Cite Me for This?

Learn about  OSHA citations issued in dentistry and how you can avoid them.  The Divas discuss real violations they have seen so you can avoid costly fines.  Be safe by avoiding these bloopers in your practice. 

• Sharps Whistle-blower Boston, Mass. https://www.osha.gov/news/newsreleases/region1/04082015
• Top ten OSHA Violations https://bit.ly/3x2KE6U
• Screening and Evaluating Safer Dental Devices.  https://bit.ly/43wzTX3
• Dentist cited for having overfilled sharps containers: https://bit.ly/49GYVVv
• OSHA - Dentistry  Overview https://www.osha.gov/dentistry
• Frequently Cited OSHA Standards Results:  https://bit.ly/3Iwuci5

                                                 https://www.thecompliancedivas.com

Transcript

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SPEAKER_00 0:05

Welcome. I'm Leslie Canum. I'm Mary Gavoni.

SPEAKER_03 0:09

I'm Linda Harvey. I'm Olivia Wann. And together we are the Compliance Divas.

SPEAKER_00 0:18

Welcome to the Compliance Divas podcast. My name is Leslie Canum, and I'll be your moderator for this podcast today. I wonder if OSHA would cite me for this. We bring clarity and simplicity to compliance by navigating regulatory compliance to keep you on course. Please subscribe to the Compliance Divas podcast for your favorite podcast channel or on our website, thecompliancedeevas.com. We have resources that we may mention during our podcast that you can find on our show notes of the podcast. So you can also submit your questions to support at thecompliancedivas.com. You know, dental offices are subject to OSHA and OSHA inspectors can issue citations. Have you ever wondered about the kinds of citations that are issued to other dental offices and what you might do if OSHA appeared in your practice? Well, today I'd like to cover some of the things that the compliance diva see when they visit dental practices that would certainly lead to an OSHA citation, if not a dental board violation, and potentially safety issues for team members as well as patients. I'd like to bring Mary on first to tell us about disinfectants. What do you see in the world of bloopers when it comes to use of disinfectants in dentistry?

SPEAKER_02 1:46

Thanks, Leslie. One of the most interesting things that I saw a number of years ago was a practice that was using Windex as a cold sterile solution, which we now call high-level disinfectants, but obviously that's not appropriate. It is not EPA registered as an immersion disinfectant. So it reminded me very much of my big fat Greek wedding where the father was spraying Windex on everything. I think the biggest blooper that I see with disinfectants has to do with people who still make up their own disinfecting wipes with four by four or three by three gauze, put them dry in a container, and then pour their solution over the gauze. And we know from studies that have been done and information that's been published in the CDC guidelines for sterilization and disinfection in healthcare facilities, that those the gauze, the fibers in the gauze, can in a very short time bind up and inactivate the active ingredients in the solution. And one study actually showed that in a container of gauze soaked in disinfectant, they actually could culture out gram-negative bacteria. So we need to either have dry gauze and dispense out the disinfectant as we need it, or buy pre-made disinfectant wipes. Of course, there's always the spray option. I don't encourage spraying of disinfectants just because of the issue that we have in dentistry with asthma, but you could certainly direct the spray onto gauze or uh paper towel that you're going to apply it with. So the biggest blooper that I would say is soaking gauze in disinfectant.

SPEAKER_00 3:42

And you know, Mary, I think that during uh the COVID pandemic, when we saw a shortage of some of the supplies that we use and some of our favorite disinfectants, we were given this information sometimes by well-meaning dental reps or by even public health departments. And so the bottom line, of course, is that we may be using a product that has no efficacy because the disinfecting properties have been diminished so greatly. But what I'd like to do now is bring this over to Linda, and I'd like you to talk to us a little bit about the bloopers you see when it comes to PPE.

SPEAKER_01 4:18

Leslie, I think PPE is a fascinating aspect of compliance because I know among us, Davis, we could spend multiple podcasts talking about the bloopers that we've seen. So I will start with the first one that is long-sleeve t-shirts under a scrub top. They are typically worn to stay warm in the wintertime, or sometimes here in the south, particularly in Florida, our air conditioning can get cold in some buildings. So it's not typically meant by the employee or to be PPE. But unfortunately, they're wearing it as PPE. And as such, they're walking around all day throughout the office with dried spray and splatter, perhaps even blood, on their forearms and across the front of their scrub jacket. And then when you take this home, you're having to turn it wrong side out when it you take your take it off. So you're contaminating yourself with the PPE. And who's to say that it's not, I mean, with your own clothes, your long sleeve t-shirt? And who's to say that there hasn't been solution that's seeped through to your arms throughout the day that you didn't even notice? So that's a really big one, Leslie. And that would garner an OSHA citation for sure. In addition, wearing the wrong protective eyewear would also garner an OSHA citation if OSHA were to step in on your doorstep and make an unannounced inspection. Either wearing no eyewear, I've seen this happen many times where the doctors are busy uh wearing their loops, and so they're looking head down. They're um metaphorically speaking, we know everybody's got erect posture these days, a little down looking in a patient's mouth, and there's the dental assistant sitting eat and eat with no eyewear on. A lot of danger for that poor dental assistant when something sprays into his or her eye, or a little fleck of a piece of tooth or whatnot, or restorative material lands in their eye. So we know from doing a previous podcast that the eyewear standards have changed, and everyone needs to be wearing either a face shield and a mask or safety goggles and a mask. And I love the face shield because I think overall it provides more protection for your whole face, forehead, chin, and so forth. The third thing I'd like to draw attention to, Leslie, is taking PPE home to launder. That is most definitely an OSHA violation. And the Bloodborne Pathogen Standard explicitly states that it's the employer's responsibility not only to provide and maintain the PPE, but also to maintain it. So the employer is responsible for laundering the PPE. I was never more happy than during the peak of the pandemic when several more of our offices elected to put in washer and dryers. So they could manage all that in-house and not have to worry about someone taking it home who wasn't supposed to, or even the doctor taking it home. The solution was solved with the laundry in-house. So I think that was a good solution. I am hearing more uh chatter, Leslie, about offices that are questioning whether they can make employees buy their own PPE. And this has been more in regards to reusable PPE, such as I wear, not so much the mask and the glasses, of course, uh, because team members are losing or breaking their PPE. So I would like to exercise caution because it's not in the best interest, nor can you nor does the bloodborne pathogen standard state that you can charge an employee for their PPE. And if that was the intent of an office, I would caution you do you have enough supporting documentation to even warrant that. Do you know that it was intentionally damaged, Leslie, to prove that was the case? So, you know, when you think about that, that would go back to all the training records and having everything in picture perfect condition. And so I think it's a route that most offices should not go down at all. Plus, I want to mention one other thing really quickly before I turn the mic back to you, and that is wearing their mask under their chin now. Uh, maybe a motion violation, may not. Certainly, if you're wearing the mask under your chin while you're in the operatory under occupational exposure, I think it would be in a violation. But what I'm seeing is that most every dental practice, starting with the doctor and every team member, has reverted back to pulling down the mask under their chin in order to speak to the patient one-on-one. And then they forget it's there and they're wandering around the office with their mask under their chin. So that's a pet peeve of my list. I just wanted to throw that in. But back to you.

SPEAKER_00 8:44

That's a lot of things to keep in mind when it comes to PPE, Linda. Thanks so much for advising us there. Well, Thivas, we'd like to take a pause here and discuss Sharps containers and the convenience and cost-effectiveness of Wastewise. We are particularly fond of the isolizer system where you collect, treat, and dispose of sharps waste in your regular trash. No contracts, no hidden fees, and no pickup service. This self-disposal system is allowed in 38 states. In the other 12 states, Wastewise is authorized as a mailback program. Now, for our listeners, Wastewise is offering a free year of Sharps self-disposal. You only pay shipping and handling. To take advantage of this free offer, send an email to info at wastewise.com and mention the divas to see their full line of products. Go to wastewise.com. That's W-A-S-T-E-W-I-S-E dot com. Olivia, I'd like you to give us some uh ways that we can avoid OSHA citations when it comes to training and documentation. Can you give us a little insight there?

SPEAKER_03 9:56

Sure, Leslie. When it comes to training, we may as well have not completed training if we don't have documentation. And so where I've seen bloopers is maybe there was a lunch and learn session, or maybe a product rep came in to share a training. They may have even passed around a piece of notebook paper to put everybody's signature on it. However, OSHA does have a certain requirement for the format of the roster. So that's really a key consideration is not only providing required training, but having the documentation to support that people were trained. And that roster should include the presenter's name and title, the date, the topics that were covered, the participants, and the participants' designation. I've seen some bloopers there where few hygienists didn't have RDH on their signature line and OSHA cited it. So they are that picky. So documentation is key to verify that we had training and that it was provided properly. And also, there's other areas, Leslie, that we see as bloopers. And a common one that I see is that there's no chemical inventory. So let's say they have their safety data sheet collection, but there also has to be an inventory to correspond with the safety data sheet collection. So it is a more organized approach than just shoving safety data sheets in a binder. So we want to catalog them, list the hazardous degree hazardous ingredients, and where it is used. And let's not forget the common blooper of safer device evaluations. It is required by OSHA. And so that's another piece of documentation that we have to update year to year to verify that we are looking at safer medical devices to incorporate into our program. And then one of the key documents for the bloodborne pathogen standard, the work exposure control plan. Not only do we draft a plan, but year to year we have to review it and make sure that it's current. So that means having some kind of timestamp on it with a signature to verify that it was updated. Then, of course, some states like Tennessee requires a sharps log. So although we're not required to complete the record keeping forms 300 and 301, uh in our state, we are required to keep a sharps log just as a how would you say safety tool to track how injuries are being uh how they've happened, what we've done to correct it and prevent it. And then also the corresponding post-exposure management reports. That too is all over the place, Leslie. If there's been a needle stick or a sharps injury, making sure that the paperwork is completed correctly. And not only that, Leslie, that it's filed correctly. We've seen where these this confidential paperwork is just shoved in a binder or in a public folder that anyone could look at. So anytime it has employee information on it, it should be stored in a confidential e-file that's password protected, or if it's paper records, under lock and key. And then that brings up the fact do you even have employee medical records? So that's another blooper. Seems like people get confused when we ask for employee medical records. They're saying, Oh, does that mean the you know the dental medical history? We we they're a patient in our own practice, and we have a dental history, medical history, but that's entirely different. So the employee medical record, as far as OSHA is concerned, is a separate component that would house verification of the HEP B vaccine and any exposure incidents. So these are really common bloopers that I see, and I'm sure that the divas collectively could uh put together a lot of bloopers, but hopefully this will help our listeners to avoid some of these common mistakes. Back to you, Leslie.

SPEAKER_00 14:12

Well, you know, it brings up another point, Olivia. When you talk about all the documentation and record keeping, I think that I hear from my audiences that they're surprised that employers have to hold these medical record keeping forms, duration of employment plus 30 years. And I always impress on the the fact that this is important for employees to know, not just for employers, because then they need to go back and find out something about maybe the vaccination series that they had or the documentation of immunity, or perhaps they had an accident or an injury, and they need to bring that information perhaps to a healthcare provider. If they go back to their previous employer and the employer does not provide them with their medical form, uh then that would be in violation, certainly. So thank you for bringing all of the those areas that are regarding documentation and training to our attention. What I'd like to do now is just spend a couple of minutes talking about some of the sharps bloopers that we've seen where citations have been issued. Mary, I think you've got probably one of the most interesting ones. Can you tell us uh more about your blooper?

SPEAKER_02 15:22

Absolutely. And this this happened a number of years ago, I believe it was 2010, when a dentist in the Boston area in Massachusetts was asking the dental assistant to remove the needle sheath from contaminated needles to save room in the sharp's container so they could get more in. I cannot think of anything more hazardous than manipulating a uh contaminated needle. And so the the employee um reported it to OSHA, filed a complaint, and then the employee was subsequently fired. And the the dental assistant um or the dentist was sued on behalf of OSHA for that dental assistant and was awarded somewhere in the neighborhood of $85,000 under the Whistleblowers Act. So that's probably the most notorious thing that that I have seen. But back in the early days of the bloodborne pathogen standard implementation, um, when many dentists were in the habit of doing two-handed recapping, we used to see a lot of that going on. And it was it was tough sometimes to convince them to um either use a needle recapping device or um not do it two-handed, do a single-handed scoop technique. And I can remember being in a practice where this doctor was bragging on how he never had a needle stick, nothing ever happened. And he was actually looking toward me when he was recapping the needle, and of course, stuck himself. And it's like, oh, excuse me, he's trying to blame it on me. That was my fault. I distracted him. It's like, you should never look away when you're doing that and you don't do it with two hands. So that's that's a tough one trying to uh to convince people sometime. But that um that particular case is one of the largest, I think, whistleblower um awards that's ever happened in dentistry that I'm aware of.

SPEAKER_00 17:37

And and rightfully so, dental assistants should not fear reporting to their employer when they see safety hazards, particularly when it's jeopardizing their own safety and an OSHA violation. And uh employers should pay attention when someone says there's a safety issue here, I don't feel good about doing this, and you know, if it falls on death ears, then where else is an assistant to go for making sure that we have a safe work environment? So very important thing to keep in mind. Olivia, can you tell us about the location of sharps containers?

SPEAKER_03 18:13

Leslie, this comes up quite a bit. Dental offices tend to be very beautiful and very conscientious of creating this wonderful environment. And a lot of the dentists do not want the sharps containers to be visible. However, the sharps containers need to be near the hazard. So if we're doing a hazard assessment in the hygiene areas, do the hygienists are they allowed, permitted through the state to do injections? And if that's the case, we need sharps containers in the hygiene rooms. We need sharps containers in the doctor's treatment rooms, and of course, one in the sterilization area in case there's one that has not been taken apart. So always think of it in terms of being near the hazard. And I could share a blooper with you, Leslie. Some years back, uh dental practice did very well in incorporating all the suggestions that we had made during the consultation, and unfortunately was randomly audited some months later. And the only thing the dentist was dinged on was that the sharps container was behind the cabinet. So, in other words, when you'd walk into the treatment room, it was hidden, mounted on the wall, but hidden on the other end of the cabinet. So the OSHA official felt like it was obscured, it was not readily accessible. So, you know, if the sharps container is visible, that's what we want to see. And as I explained to my clients, that, you know, when you go into a doctor's office, how many of us say, oh, I think this doctor's office is so ugly because there's a sharps container on the wall? So that's not the case at all. So we want to promote safety, making sure that it's placed properly. NIASH does provide us some instructions on the exact placement uh for height based on the average height of a healthcare worker. And so hopefully that will help our audiences to see the bloopers of what other people have done and avoid those same mistakes, Leslie.

SPEAKER_00 20:22

Olivia, that reminds me of another blooper I saw with the sharps container. And this is sort of a common way a dental office might be set up where drop-throughs are uh where the sharps container is underneath the cabinet and there's a hole in the counter. So uh the assistant or doctor only has to remove the contaminated sharp and release it right into a hole in the counter. Now that would be obscure, however, it would be clearly identified as a sharp's uh drop container. But here's the blooper is that sometimes I see these countertops manufactured in a way where the treatment room has a sharp's drop and they have a trash drop right next to each other. And in the last dental practice where I conducted training, going through their practice, they had covered up their trash drop because they said that sometimes there's a misfire and and occasionally someone won't be thinking and accidentally drop a sharp into where the trash container is. So they just discontinued using the trash so that that would not happen. I would encourage anyone that's designing a new dental practice to think about uh where the proximity of the sharps container with all that you put had mentioned to keep in mind keeping it from being obscure and then keeping it from being misidentified uh by having the trash misidentified as a sharps container. So those are important things to keep in mind. And I came across um quite a blooper in California where we had a dentist who was very well meaning and was actually cited a total citation of $8,100 because his sharps container was overfilled. Now, it was an interesting case because the complaint that was filed against the dentist was for um the hygienist had a operator stool uh that was not uh functioning properly. And so when it was not repaired properly, she felt it was a safety hazard. She brought it up over and over again. You know, I know how it is when dentists are asked to purchase new equipment. It's an investment. But um she finally had to take her concern to OSHA because she wasn't getting any kind of remedy to a faulty stool. And when OSHA came in, the doctor had replaced the stool by then, but they went ahead and did a full-on inspection and found that there were sharps above the fill line on sharps container. So we need to be mindful of that. And $81,000, pardon me, $8,100 is a lot of money to pay for a citation for simply not paying attention to the fill line. And to Mary's point, uh her the fee of $85,000, the doctor was trying to save money on either sharps containers pickup or or the number of sharps containers. Boy, you could buy a lot of sharps containers for $81, $85,000 and you could have them picked up on a daily basis for that kind of uh fund. So is there anything else that anyone else wants to chime in on before we close this podcast on bloopers that you've seen? Mary, tell us what you've seen.

SPEAKER_02 23:21

And I think Olivia touched on this, but I just want to reinstate that um many times practices will have smaller sharps containers in their treatment rooms, and then they take them and open them up and dump them into the larger container that they may keep in the sterilization area, and that is not appropriate. You never, ever, ever open up a sharps container. And many practices also believe that they if they disassemble their trays in their sterilization area, that's where the sharps container needs to be, but they also need them in the treatment rooms.

SPEAKER_00 23:59

That's right, Mary. And uh there would be questions as to uh what happened if an accident occurs and the sharps were not disposed of at the point of use, why were they being transported to another area? So that makes a lot of sense. Um I've seen a couple of other things that have come up with regards to improper use of uh, for example, a company called Wastewise makes a product called Isolizer. And I was in a dental practice, what they were doing instead of placing the sharps into that isolizer container and treating it with the catalyst and the activator, they were just simply activating the solution and then pouring it into other sharps containers and then throwing them in the trash can. We need to be mindful about how we're disposing of sharps and if we are going to treat them on site in the 38 states that allow you to do that, you need to follow the manufacturer's directions for use. And we also need to make certain that when we are working with sharps containers, that we understand that there's some regulations surrounding how often they need to be picked up. And we can check with your own state requirements to make sure that they're being picked up or removed from your practice or treated and disposed appropriately. Another blooper I'd kind of like to make sure we cover is uh expired products. When I've been visiting my dental offices lately, I've been seeing disinfectants that are sprayer bottles of disinfectants, usually in the lab, sometimes in the treatment room alongside the bottle of wipes, and they're being refilled by gallon jugs. And the gallon jug is certainly within the current usage date, but the sprayer bottles, those darn things sometimes last for you know three, four, five, six years. And I'm seeing expiration dates that are uh on the sprayer bottles, they're being refilled from the gallon jug. And so, how would you explain to OSHA that this you're not using expired disinfectant if you don't transfer the expiration date? It's a simple thing that you can do with a piece of tape or you can use uh a little sticker or something to indicate that you're um on top of your expiration dates. And then I would remind uh our our clients and audiences and and podcast listeners that there are many other things that expire from dental materials to anesthetic to uh even electronic defibrillator pads if you have an uh AED in your practice. So keep mind, uh keep your eyes on those things. And we also want to mention at the Compliance Divas, we've done multiple podcasts on OSHA, OSHA compliance, sharp safety, uh, chemical safety. We even have uh a podcast with a retired OSHA inspector from Tennessee, where Tennessee is known to be very aggressive with dental practices. And there's a lot of information that you can gain for your uh team meetings by listening to the compliance divas podcast. We bring clarity and simplicity to compliance by navigating regulatory compliance to keep you on course. Again, submit your questions to the compliancedevas.com and uh take a look at the resources that are on our show notes. And we would love if you would uh give us a little um review at the podcast on your podcast station. Just scroll down to the bottom and take a look at where you can uh provide reviews and share the podcast with your team members. Dental professionals all over the country are finding this to be helpful, free, and a great way to make sure that they stay in compliance. That's it for today.