The Compliance Divas Podcast
Our podcast covers current topics such as infection prevention and control, OSHA and HIPAA compliance for dentistry. We discuss the latest regulatory information, answer frequently asked questions and give suggestions for dental practices to make compliance easy and sustainable. The Compliance Divas are a trusted source for consistent, accurate information based upon current guidelines, standards, science, and recommendations.
The Compliance Divas Podcast
#184 Insights from an RDH and Former OSHA Inspector
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In this episode, the DIvas interview Caitlin, a hygienist who served as an OSHA compliance officer for the state of TN. Caitlin shares important details about OSHA inspections, top violations and how important it is to be cooperative with an inspector if they come to your practice.
Resources:
- OSHA Fact Sheet on Inspections https://www.osha.gov/sites/default/files/publications/factsheet-inspections.pdf
- OSHA Establishment Search - Data on OSHA Inspections https://www.osha.gov/ords/imis/establishment.html
- OSHA Inspections, Citations, and Proposed Penalties https://www.osha.gov/laws-regs/regulations/standardnumber/1903/1903.3
Welcome. I'm Leslie Cannon. I'm Mary Gavoni.
SPEAKER_02I'm Linda Harvey. I'm Olivia Juan, and together we are the Compliance Divas. Welcome to the Compliance Divas Podcast. My name is Olivia Juan, and I'll be your moderator today. In this episode, in this episode, we are discussing the top pet peeves of a former OSHA inspector. Have you ever wondered what the top pet peeves are of an OSHA inspector? We are going to interview Caitlin Dennison. Caitlin was formerly an OSHA inspector, turned dental hygienist, and now works for Modern Practice Solutions as a compliance trainer and consultant. And we're going to talk with her about her background. As the Compliance Divas, we bring clarity and simplicity to compliance by navigating regulatory compliance to keep you on course. Please subscribe to the Compliance Divas podcast through your favorite podcast channel or on our website, thecompliancedivas.com. Any resources that we mentioned during this episode can be found in the show notes. If you have any questions, please email us at support at thecompliancedivas.com. And don't forget, please give us a review. So Caitlin, I want to interview you first just to get a better idea of your background. If you want to share with our audiences about your background.
SPEAKER_00Yeah, absolutely. So I got my undergraduate degree in biology. And initially I thought I wanted to go into healthcare, but was steered in a different direction. And I ended up working my first big job in Chattanooga as a compliance officer, which is essentially an inspector for Tennessee OSHA in the Chattanooga area. And after working for OSHA for a little while, I wanted a change and I wanted to give healthcare a trial. And I had the opportunity to go back to school for dental hygiene. So I went to Chattanooga State and got my dental hygiene degree and worked clinically as a registered dental hygienist. And from there, after working clinically for a little while, I wanted to get back to the compliance aspect of things and felt like my dental hygiene knowledge would be useful. So I was lucky enough to start working with modern practice solutions doing compliance for the dental practice specifically.
SPEAKER_02That's so interesting, Caitlin. And also want to mention some of your hobbies, which I thought was cool. Tell our listeners what you enjoy doing when you're not working.
SPEAKER_00Yeah, well, I like the reason I moved to Chattanooga, admittedly, was not to be an OSHA inspector. Um, it was to rock climb. And so we do quite a bit of rock climbing. I had a brief paragliding stint. These days do a lot of biking and running. So yeah, it don't worry, it's not all compliance all the time.
SPEAKER_02Well, that's good to know. So do appreciate that you're an outdoors person. I know Mary is anxious, having been a dental hygienist as well, to pick your brain. Mary.
SPEAKER_01Well, welcome, Caitlin. We're so excited to have your expertise with us today. And I am dying to know what are the pet peeves of an OSHA inspector and what's what's the top violation that you typically would see?
SPEAKER_00So I would say across all industries, and this definitely applies to healthcare and dental offices, the lack of safety data sheets is a very easy citation to find in most workplaces. That's a that's a standard that applies to just about everybody, certainly to dental offices, and it's it's very common to see those missing.
SPEAKER_01Anything else that like can you give us some ideas of how you were treated if you came into a facility, or did people like were they disrespectful to you or were they afraid? What what kind of tell us what the demeanor is when you go into a facility?
SPEAKER_00Yeah, I think I really liked the regulatory aspect of OSHA. I like interpreting regulations, but the relationships with employers could be very difficult, especially on like construction sites or larger manufacturing facilities. Oftentimes they're very not happy to see you. Um, and so your reception is usually quite cold. And that can be difficult because you do want to relate with people. And OSHA is an important agency that does important things. And I think it can just be hard for a workplace to see that when you're coming in sort of from a punitive angle. So that was difficult. Honestly, that was the hardest part of being an inspector.
SPEAKER_01Did people try to like argue with you that what they're doing is really okay and it's not unsafe?
SPEAKER_00Yeah, definitely. I think most of that would come. So we'd have a closing conference and discuss the citations or discuss potential citations. And then oftentimes it was sort of a drawn-out process after that because they would receive the citations and maybe that's not what they expected based on their inspection, and then we would sort of begin the process of several phone calls and emails to discuss their citations. Um, but certainly most people don't think they should be getting cited. Um, and especially since we tended to interpret things pretty close to the letter of the standard, and you have a little bit of leeway there, but we tended to interpret it pretty strictly, I would say.
SPEAKER_01That's great information. Thank you, Caitlin. A little scary.
unknownYeah.
SPEAKER_02I know you have Leslie wanting to ask some questions too. So, Leslie, what's on your mind?
SPEAKER_03Well, one of the things I think that comes up a lot of times when I'm talking with people in dental offices about compliance is questions about sharps and transportation of sharp contaminated instruments. Can you tell us what your position is on, let's say, contaminated needles, sharps containers, and then treatment trays in bringing treatment trays and perhaps bringing needles to the sterilization area. What is your best tip for dental offices to keep them safe?
SPEAKER_00Yeah, I think that's something that's often sort of forgotten about for some dental offices, because once we start cleaning, we sort of we've been so focused on our patients, sometimes we stop thinking about safety generally. I would say for disposable sharps, for example, your disposable needles off your aspirating syringes, you'll always want to make sure you have a sharps container. The way the standard phrases it is as close as feasible to where the sharp is used. So make sure you have those sharps containers readily available. And I always interpret that standard to mean in every operatory where there could be a disposable sharp used. And arguably, you're going to have a hard time explaining why your one operatory could just never ever have a disposable sharp. So I would put those just in every operatory. And then when you're moving your contaminated reusable sharps from your operatory to sterilization, remember that we want to see those in a container that is leak-proof and puncture-proof to be transported. So even your cassettes, and I always say this in my training, the cassettes look like a container, but they're neither leak-proof nor puncture-proof. So they won't meet those requirements. So it's sometimes it seems, I remember in hygiene school, it always seemed really silly to put your container in a container, but it is the standard. And as you can imagine, you could have an injury through a cassette. Great information.
SPEAKER_03And I think today I'm seeing more and more dental offices subscribe to having some kind of a container. And the ones that don't have a container, it's interesting the comment I get about whether they should have locking lids on treatment trays or whether they should have a container is that, well, this is the way that we've always done it. And no one's ever said that we can't do it this way. I don't know anybody that has containers or tubs for their instrument transportation. I was at one practice last week where they had a locking lid container. It's about twice the size of a shoebox with their biohazard stickered on it. And I said, you know, where did you get that? That looks really great. And they were telling me that they were able to get them fairly inexpensively. And they ended up costing about $2, $2.50 each. And I thought, you know, I'm going to start bringing those with a biohazard sticker to my clients so that they can see how simple it is and how easy it is to you can transport more easily in a container rather than having to go back and forth so many things from the treatment room to the sterilization room. So, you know, in my opinion, why wouldn't anybody want to do that?
SPEAKER_00Absolutely. And having been a hygienist, I could picture I was lucky I did not have any offices that did not have those containers. But just imagine having to walk from your operatory to sterilization. What if you tripped? What if you spilled something? I mean, hasn't happened to me, but I'm sure it's happened to someone. And that just sounds horrifying.
SPEAKER_03And another thing I wanted to ask you, because I never get exactly the right answer on this. Um, is it okay to have your sharps container, let's say, under the counter, like maybe where the sink is and where you would have to open up a door and put the sharps in? Or is it better to have it on the counter or mounted to a wall?
SPEAKER_00So your sharps container needs to be readily accessible. Your sharps container cannot be obstructed. So you don't want to put it inside a cabinet. You also don't want to set it somewhere where it could easily be knocked over. So we'd ideally like to not see them sitting in the middle of a counter, bracket it to a counter. That's always a good idea. We don't want to accidentally knock it over, don't put it by a light switch where you might hit it. Um, sometimes it seems like putting it in a cabinet is the safest thing, but when you think about the process you'll have to go to to access it, you can sort of see the hazard there.
SPEAKER_03Um so Caitlin, our Viva Linda is not with us today, but she was very curious to know what is the next big violation or thing that we should watch out for in dental offices, in your opinion.
SPEAKER_00I think another common violation to be aware of is making sure that you have your eye wash stations properly installed, make sure that they are functioning, that they're delivering tepid water at the appropriate rate. And this sounds really silly, but in the direction of your eyeballs. Having seen several eye wash stations that sprayed nowhere near the area you would need it, make sure you're testing those eye wash stations and that when the inspector comes in, they're able to get it to function appropriately. If it only works on Wednesdays and your inspector comes on Monday, it's not going to cut it. So be sure that your eye washes are functioning. And I always say during my trainings, you don't want to find out that your eyewash sprays boiling water or ice cold water when you go to rinse your eyes for 15 minutes. So that's near and dear to my heart as someone who worked clinically and could have been exposed as well.
SPEAKER_03Can you tell us if it is okay to go underneath the sink and turn off the hot water if it was a situation of boiling water? I mean, I'm not sure how that would affect cold water if it was really cold weather. But do you have a suggestion on how to best come up with tepid water?
SPEAKER_00That's a good question. I don't believe you would want to show off either valve for hot or cold since it does need to be tepid. You don't want to go too far in one direction. But as far as the standard goes, uh, tepid is the phrasing for the standard.
SPEAKER_02And that's accomplished with a mixing valve. So it usually involves a plumber installing it so that the water is neither cold or too hot. And I think that Caitlin brings up a good point. We've we've seen eyewash stations splash out on the wall instead of to the user. And it understandably that wasn't the intent of the person that installed it, but obviously it wasn't tested. So if dental team members are testing it weekly, these are deficiencies that they would identify, no doubt. What's your thought, Leslie?
SPEAKER_03Well, you know, one of the things that that always surprises me is that when they installed the eyewash station, the typical one that you see that goes on the end of the faucet that has the little button that you pull, they think that the button goes toward the wall because it looks like that's how it should be installed. And so, as a reminder to our listeners, if you do have the button, what I always tell my clients is it's belly button to belly button. That button should be facing your belly button, and that way the flow of water will go out at your eyes. And then I say, otherwise, you would have to climb up on the counter and lean your head over, looking at this thing from the opposite direction in order for that flow of water to get your eyes.
SPEAKER_02That's a good point, Leslie. So, Caitlin, obviously, you're a a wealth of knowledge, both from the compliance arena and also with your dental hygiene background. How would you say that your role, a hygienist, helped you now as a compliance trainer and consultant?
SPEAKER_00Yeah, having the dental background helps enormously. One thing I tell my clients is that your OSHA inspector may not be an expert in the dental office. As an inspector, I had to inspect a steel foundry one day and then maybe a McDonald's and then a dental office. And so you don't always have enough time to become an expert on that area. So as an inspector, on my first dental inspection, I didn't understand why these offices were using like aspirating syringes and recapping their needles. And I didn't understand forehanded dentistry because I didn't have a dental background. Whereas now all of that is much more clear. All of the equipment makes sense to me, and I'm much more easily able to relate to the dental employees because I know exactly why they're doing what they're doing. It also gives me a little bit more, I would say, empathy for the dental employees who are implementing the regulations because I understand where they're coming from with their job and the tasks they have to accomplish while also remaining compliant. But generally, understanding the understanding the equipment and procedures is very, very helpful.
SPEAKER_02Caitlin, let me ask you this what would you say, and I know we've talked about this before, but let's say someone, an inspector comes in from OSHA, and the team member or dentist, what have you, is rude and difficult to work with. Having been an inspector, how did you feel about that when there was difficulty in doing your job as a previous OSHA inspector?
SPEAKER_00Definitely it helps if the employees are compliant and understand that that OSHA inspector is just there to do their job. It's also, I would say, useful to be useful for your OSHA inspector. Oftentimes the inspector is asking questions so they can better understand your process and understand why you're doing things the way you're doing them. I think in facilities where the environment was more hostile, it could be difficult to obtain the documents you needed or to obtain the information you needed. And if you leave the facility without the information, oftentimes the assumption is that they don't have it. So certainly you want to be as prompt as you can with the inspector, be respectful, and do your best to educate the inspector where you can, because really they just want to understand your process. And you know, the day before they may have had to understand the process of making biodiesel. And today they just want to understand how you give dental injections. And it's gonna be a lot more easy for them to see things from your perspective if you help them out with that.
SPEAKER_02So arrogance shouldn't play into it, right? All right, so I'm gonna go to Leslie and then to Mary.
SPEAKER_03I think our listeners would be very interested in knowing some of the things that they should do and shouldn't do. You had mentioned not to be argumentative and not to be not sharing information to be to educate. When an OSHA inspector comes into a dental office, let me just start by saying, what are some of the top violation type things that they look for? You mentioned eye wash station, you mentioned sit not having safety data sheets, and we talked about sharps containers, but what else should people be aware of as far as safety goes? Is there anything in that maybe is not exactly dental related, but does pertain to any business that you would say is a safety hazard that you come across again and again?
SPEAKER_00Yeah, so for dental offices, the thing I say in my training, and then I'll get into some more specifics or general safety regulations, but for dental offices, your inspector may not know that much about dentistry, but they do know that dentistry involves blood. And so before I did a dental or medical inspection, I brushed up on that 1910, 1030 bloodborne pathogen standard. So I would just read through it. So you want to make sure that you are hitting each item in that standard as an inspector, making sure they have each of those things. So be sure that you have your written documentation on file for that standard. Make sure that the OSHA inspector can easily look and see how you're maintaining compliance with each aspect just by reading your manual. Because if the inspector gets home and forgets what they saw, they're gonna say, well, is it in their policy? And they're gonna flip through that. And they also know that dental facilities have chemicals. And in fact, this is true for just about every workplace. We all have some kind of chemical. So they're gonna be looking at that hazard communication standard. And then as far as more general safety regulations, the way OSHA works, briefly, you'll have a health type inspector. So I was an industrial hygienist, so I looked for health hazards, whereas safety professionals look for safety hazards. However, even as an industrial hygienist, I was expected to look for basic safety hazards. And I was not an expert on safety hazards, but I knew my basics. Make sure your exits are labeled and your exits are not blocked. Um, making sure that your circuit breakers are cleared. And then a big one that I've seen a lot lately make sure that your exits are labeled, and then your doors that are not exits need to be labeled. And I always say if it's a door that goes to nowhere, label it as not an exit. If it's a closet, label it as a closet. So those are really easy hazards to cite for, even for an industrial hygienist.
SPEAKER_03Wow. Thank you. That is great. I love that explanation. Thanks so much.
SPEAKER_01Mary, back to you. My question is, and and I get asked this all the time. If say a state, and I know in in Tennessee you had a focused inspection program for a while, so if an ocean inspector showed up and you had no idea that they were coming, you there wasn't a complaint, they just showed up. If they're having a really busy, crazy day with lots of patients and maybe even some like special needs patients there, how is it perceived and or received by an OSHA inspector if you're asked to come back at a different time?
SPEAKER_00So for Tennessee OSHA, the inspector has a little bit of discretion. They can wait a specified amount of time until the designated professional is available to meet with them. So you have a tiny bit of leeway. However, that inspector more than likely is not going to wait over an hour to come back to your facility. And as an inspector, if I wanted to do that, if I wanted to wait a moment, say the person on site who could answer my questions was 20 minutes away and I needed to wait to begin the inspection, I would need to contact my supervisor and get there okay before doing that. Um, but I think in many cases you would be hard pressed to have them wait an extended period of time. Of course, the hazard there coming from an inspector is you might magically correct your hazards in that time period.
SPEAKER_01Sure. I imagine the perception is that they may not have documentation, that they're trying to correct it and do whatever. But I would also guess that if someone Were to be ever so respectful and say, hey, we're happy to meet with you. Can you give us maybe an hour? Because the people that you need to talk to are really involved in patient care right now, that hopefully, if they've treated you well, that you'd give them that leeway.
SPEAKER_00Yeah, it it's one of those things that definitely matters how you ask. And they are bound by the regulations of the state as to how long they can wait. And of course, by their what how their supervisor feels about that as an inspector. But certainly, if you're going to make that request, make it reasonable and explain. It makes the OSHA inspector's job easier if someone who knows what's going on is there. So it could potentially be beneficial for both if it's depending on the situation.
SPEAKER_02Sure. So our listeners may be aware that Tennessee had the local emphasis program, which triggered random audits and the dental community was constantly on edge because someone would walk in. Could you explain, Caitlin, the process of a warrant?
SPEAKER_00So if you deny access to your fill facility when the inspector arrives, I had somebody ask me this at a seminar the other day. What happens next? Well, luckily, as an inspector, I did not have to get a warrant ever. But what would happen, say you arrived at the dental office and they refused you entry after you identified yourself as an inspector? You would have to go back to our office and request a warrant. Um, certainly denying entry is not going to, if anything, it's just going to delay your inspection. Um, but they would have to get a warrant and then they would come back and be angrier.
SPEAKER_02Isn't that true, Caitlin? But the best thing is make sure you're in compliance, right? Leslie, did you have another thought?
SPEAKER_03Yeah, I just wondered, like as Mary said, perhaps it's a day with lots of patients, patients that need everyone's attention. So it would not be acceptable to say, could you come back tomorrow at when we can reserve some time and our our practice isn't going to have patients uh that are waiting to be seen, or perhaps it's a danger to them for us to be having to focus on you and maybe for you as the inspector to not have the right PPE and be going through our clinical area. Can they can they use any length of time, or are you telling us it's really only like an hour that they could delay their time with you?
SPEAKER_00I do not believe that an inspector would allow you to wait that long of a period into the next day. It is not permissible for inspectors to give advanced notice of their inspection. So I do wonder if that could be considered advanced notice. It would be the state-by-state regulations as far as waiting for someone to arrive for the inspection.
SPEAKER_03So, in other words, you better be prepared, have your documentation in order, um, uh advise your team how to how to respond respectfully to an inspector. And otherwise, it can make it a whole lot worse.
SPEAKER_00Yes, absolutely. Certainly, you don't want your inspector to need to go and access a warrant in order to inspect your facility, that is not going to make your job easier. Is that specific for Tennessee? Yes, this is yes, because this is the Tosha Field Operations Manual. Essentially, for Tennessee, if the management official who you would like to speak with the inspector is not available, they are permitted to ask the inspector to wait to begin the inspection. However, it can't be an unreasonable amount of time and it should not normally exceed one hour.
SPEAKER_02That's great information, Caitlin. And that's the whole point. Even though you're super busy, OSHA wants to see what happens because that's when injuries happen. So it makes sense that you want to see people in their normal working order. And as trainers and consultants, when we go in, uh, and all the divas do very similar services, we want to see normal activities. We want to see those instruments move from the treatment room to sterilization at the busy, busy paces that people maintain. This has been an amazing episode having the opportunity to pick Caitlin's brain. She's so smart and experienced, despite her youth. She's just incredibly brilliant, and we're very pleased to have her in the dental space, both as her past experience as an ocean specter and her experience as a dental hygienist. As the compliance divas, we bring clarity and simplicity to compliance by navigating regulatory compliance to keep you on course. Please submit your questions to support at the compliancedivas.com and check the show notes for any resources that we discussed. Thanks again for tuning in.