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
#186 A New Standard in Eye Safety for Dental Professionals
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Flying debris during dental treatment can cause eye injuries! Listen as the Divas interview Dr. Peter Arsenault, a dentist who is a change agent for better eye protection for dental professionals and is responsible for a new, enforceable standard for eye safety in a the dental setting.
Resources:
- OSHA Standard 1910.133 Eye and Face Protection https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.133
- MA Dental Journal - A Comprehensive Study Evaluating Dental Patient Eye Safety with a Focus on Biological and Physical Hazards https://mydigimag.rrd.com/publication/?i=835994&p=34&view=issueViewer
Welcome. I'm Leslie Cannum. I'm Mary Gavoni.
SPEAKER_01I'm Linda Harvey. I'm Olivia Long, and together we are the Compliance Divas.
SPEAKER_03Hello, my name is Leslie Cannum, and welcome to the Compliance Divas Podcast. We bring clarity and simplicity to compliance by navigating regulatory compliance to keep you on course. Subscribe to the Compliance Divas podcast for your favorite podcast channel or on our website, thecompliancedeivas.com. Any resources that we mentioned today on our podcast can be found on the show notes, or you can go to the compliancedeivas.com website, click on the episodes, and scroll down to the show notes. You can also submit your questions to support at the compliancedevas.com. I'm super excited today for a podcast on a new standard in eye safety for dental professionals. We have with us today a special guest, Dr. Peter Arsenaux, who is a professor and the dependent of operative dentistry at Tufts University School of Dental Medicine. He has a background in plastics engineering and dentistry, and he holds multiple patents and is a fellow of the National Academy of Inventors. He's a leader in clinical practice, education, product innovation, and he blends expertise in dentistry, engineering, and business to advance the field and mentor future professionals. Dr. Arshneau has spoken at a group that I belong to. Everyone that has listened to our podcast in the past has heard of OSAP, the Organization for Safety of Sepsis and Prevention. And now it's known as the Association for Dental Safety. And he had an amazing presentation on eye safety. It was very eye-opening for me, to say the least. I've seen him a couple of times present his information. And I really like to just let him take over from here and just tell us about his experience with eye safety and an injury to his eye. Could you just tell us a little bit about your experiences, Dr. Arsenal?
SPEAKER_00Sure. Thank you, Leslie, for the kind introduction and warm words. And thank you, everybody, for having me. So I became sort of interested in eye safety and dentistry by accident, actually. And how it all came about was one day I was practicing in my practice, and um I believe I was removing an old sort of defective amalgam restoration, and that's a silver filling. And um in the process of removing it, I was wearing, just to paint the picture, all the appropriate personal protective equipment. So I was wearing a OSHA standard safety glasses that were compliant with the Z87.1 standard. I was wearing a mask, a surgical mask, and everything. And the side shields, et cetera. And in the process of removing this filling, if you will, a chunk of it um flew out and hit me in the eye somehow. And I ended up that afternoon in the emergency room. And it was a uh harrowing experience, no long-term effects, thank God. But I walked away with a patch on my eye and um antibiotic drops and a few things, and uh, and it was eye-opening. Ha ha. But um, so that was it. And I kind of just, you know, glad it it was over with, type of thing. And you know what? It was probably a couple of months later, I was adjusting something in someone's mouth, and I was feeling stuff hit my eye, and I was I had my eye protection on and I had everything on. I was like, what is going on here? So um, kind of long story short, I I did some serious thinking because I said, gosh, this is this is a problem, and started investigating and looking into it and did some uh modeling, if you will, where I took mannequins and I based the mannequin to be sort of in a position of the dental health care provider and uh did what was called spray studies, where we sprayed towards the face a die. And lo and behold, what that spray study found was that the safety glasses protected you from perpendicular trajectories, the side shields projected you from side trajectories, but there was this unaddressed space called bottom gaps, and that's the big word of the day. And bottom gaps are that space between the lower rim of one's eyewear and the cheekbone or the top edge of the mask, and we found that's where uh all the debris is entering. So um the research uh was published, and it garnered great interest in the personal protective equipment and safety world in dentistry and healthcare. And you know, we spoke a little bit about it and toured a bit and brought some awareness. And in the research phase, what we found that 70% of all dentists and healthcare providers received some degree of ocular trauma in the course of their careers. And we found and narrowed that it's mostly through bottom gap exposure. So this was pretty you know groundbreaking what we found. And one day I got a call from NIOSH, the National Institute of Health and Occupational Safety, and they were very interested in the research and publications, and they asked if they could sort of duplicate it at a much higher, more sophisticated level. And um they did it in their labs. And actually, the gentleman conducting the research used that as his PhD thesis, and he got his PhD with that. So, anyway, it started really taking a lot of traction. And I started lecturing around about eye safety and dentistry, and this lo and behold, this thing called bottom gaps. And um, Nyosh from there actually found that there was a huge shortcoming and bottom gap exposures. And and as a result, we we consulted and we worked together and we developed a new safety standard, which came out in 2022 that addresses bottom gaps. And um, that's a new ANSI standard. Um, it's called Z87.62. And that particular standard, um, it's the American National Standard for Occupational and Educational IN Face Protection devices for preventing exposures caused by sprays or spurts of blood or bodily fluids. So there's up to that point, there's been no standard of care to protect bottom gaps against biological hazards. And so that's a standard that came out actually end of 21, but it pretty much hit the market in 22.
SPEAKER_03That is amazing information, Dr. Arsnow. Ardeva Linda had a couple of questions for you.
SPEAKER_02Thank you, Leslie. Dr. Arsino, we're so happy to have you here. I've been following your work, and we all know how delicate our eyes, but a delicate part of the body the eye is. And it's unlike some other part, you know, our finger or hand, we might get a cut and the body's going to heal itself. But I, you only have two eyes, and you don't have a chance to have another eye. So it's so very important to your research, and we're so glad that your vision has fine as a result of your incident. Um, but there's one other organization, and that's OSHA, that says uh what we should wear for eye safety too and face protection. Could you address how ANSI and OSHA come together and what should we currently be doing and recommending to our clients?
SPEAKER_00Sure. So um OSHA is sort of like the um the um the governing body, if you will. And the way OSHA, and we presented all this information to OSHA. We went actually to Washington, DC, and and presented. And so what OSHA told us was that um OSHA standards um in incorporate a particular reference from ANSI. And so ANSI is the body that sort of makes the standard and OSHA will enforce it. So the the standard that addresses eye safety that OSHA follows is standard number 1910.133, and that's that's the particular standard that OSHA looks at. And so as technology evolves and improvements are made, um, OSHA sort of morphs and follows those improvements. And so it's very cumbersome for OSHA to keep rewriting their standards. So what they do is incorporate initial language in their standard that allows their standard, and in this one particular 1910.133, to evolve with the times. So, for example, the way the standard is written, it says that the employer shall ensure, and I'm quoting, that each affected employee uses appropriate, and they highlight the word appropriate, eye or face protection when exposed to eye or face hazards from flying particles, molten metal, liquid chemicals, acids or caustic liquids, chemical gases or vapors, or potentially injurious light radiation. The key word to remember is OSHA uses the word appropriate. And so as standards evolve, technology improves, we discover more, like we've we did with this research. Um this research is now covered under what's now an appropriate. And because the research has been vetted, it's been published in peer-reviewed journals, it's been presented at academic levels, it's now, and and ANSI has created a new standard. This is now the next level of appropriate eye care. So essentially, anybody or any employer who does not offer bottom gap protection could be liable. And if if if an employee is injured. So one of the lectures that I was traveling around giving was called Eye Safety and Dentistry and Associated Liability. And so the goal of that lecture was to discuss the new and improved standards and all the findings, and to sort of give the listener an awareness of what's now appropriate so that they wouldn't be stuck in a liable situation if one of their employees were to be injured.
SPEAKER_02Thank you so much for that insightful information because you know we it changes and trying to help offices stay abreast of that information. And I think you nailed it when you said the next level of eye safety. And certainly, you know, dentists, hygienists, all the practitioners are always looking to stay abreast of the next technique or restorative material or device that's on the market to provide even better patient care. Now we need to look at safety wear for the best level and next level of safety protection. Thank you so much.
SPEAKER_03Dr. Arshano, Ardiva Mary isn't with us today, but she wanted to ask you about the shortcoming of the OSHA standard. What problems or solutions would you offer?
SPEAKER_00So that's a great question. Uh, in terms of the shortcomings, um right now, the I I would say the greatest shortcoming is this awareness. So I'd like to go back to you folks, and I was really um excited that you um wanted to talk about this because I think by us meeting and and bringing about this awareness is addressing a shortcoming because my biggest stumbling block, if you will, was the fact that um we've had a difficult time getting the word out. It would be very sad to see if uh, say, for example, an employee is injured because there wasn't an awareness. And um and a liability case you know followed as a result. That would be very, very unfortunate. So by us gathering and and and disseminating this information and sharing it, um, hopefully people will will will hear this and learn what is appropriate. So I think one of the greatest shortcomings, if you want to be direct, is that I don't see OSHA actually marketing this or communicating this new appropriate level of eye and face protection. It's up to us and academics to do so. So, you know, I would love it if OSHA sent out sort of informational risk blurbs or new and improved things that we should be looking for. But, you know, on in their defense, they're probably such a large body. Um, and and not only do they look at, you know, dental health care providers, they're looking across all occupational industries. So that may be a lot to ask for. But um, so you essentially have to look for the information. So that would be the shortcoming, I think.
SPEAKER_03Well, that's uh pretty important then to get this message out about appropriate protective eyewear. I know I mentioned it in all of my lectures, and what I'd like to do is uh turn the microphone over to Olivia, who is our legal eagle. She's an attorney, and she absolutely understands every bit of what you had said about the liability part. So, Olivia, you had more questions.
SPEAKER_01Yeah, no, first of all, Dr. Arsenault, I I think this is very educational, and I hope that our listeners take advantage of not only listening to this, but presenting this information to their teams. What I have found, I'm in my 25th year of consulting, that when we do on-site audits, hands down, every location we've ever audited has failed on eye safety. You may have we may have majority wearing appropriate PPE, but there are always infractions that we note related to eye safety. Either they're not wearing safety glasses at all, or they're wearing prescription glasses, and I'm very concerned about it. Uh, we've been following your information for years, very passionate about it. All the work that you've done in improving for bottom safety of the glasses is incredible. So I just want to tell you how much we appreciate that. This number is staggering. 70% of the dentists had ocular trauma. That's incredible. Uh, but I do want to find out a little more about what would be the most up-to-date standard of care regarding eye safety in dentistry and bloodborne pathogen and debris protection. What are your thoughts on that?
SPEAKER_00Thanks, Olivia. I appreciate your uh your support and and interest. Um so having the new uh standard established, it sets a benchmark and a reference point as to what we as um healthcare providers have to address. So we we kind of look at it with an engineering mindset and we we look at a problem, identify the problem, and we we need to find a solution. So you what all the research has ultimately led to is the fact that um, and this this is the problem, that the combination of a mask, a regular flat mask, cone mask, um, N95 mask, whatever mask you choose to wear, um, and the protective eyewear is not in compliance with OSHA 1910.133. And the reason is that this combination would not prevent uh reasonably foreseeable debris from reaching the practitioner's eyes through the said bottom gaps. And and so that's sort of uh you know the the gist of the problem. So with the problem, we need a solution, and and this is what the research has found um that the solution is to very simply close the gap, close the bottom gap. Just like side shields are a standard, now bottom gaps are shields, bottom shields are a standard, and that's all we have to think of it. So now we the next question is what's the current technology on the market available? And um so uh back up for one second. Um whenever whenever you know the beauty about American uh innovation is that um and how this country has grown to be what it is today, is that when problems arise, um, we find solutions, and that that is what's called innovation. You know, just for example, when automobiles were first invented, they didn't have seat belts. Okay, and people were getting into accidents, and then somebody invented something called a seatbelt, and they found that the seat belts greatly reduced fatalities. So that became the standard. Now the same analogy applies to bottom gaps. We're finding that, hey, there's a there's a large majority of providers in the healthcare field that receive some degree of ocular trauma through bottom gaps. We have evidence-based research, we have a new standard, and so now we have seat belts for the eyes, and that's called bottom gap protection. So the current technology, um there's masks with face shields that come up from the mask, there's visors, there are uh varying products that address bottom gap protection. And getting back to the innovation piece is when you see a problem, it it allows and lets our minds invent and develop better products. And so there are products out there that offer bottom gap protection that are involving, that are evolving and hitting the market and allowing um comfortable compliance. That's the key. So you have to find protection that's comfortable and that uh meets the provider's needs. And so innovation is occurring as we speak, new products are hitting the market, and um that's how we're addressing uh the sort of shortcomings of the problem.
SPEAKER_01It's interesting, and I like the way you mentioned about you know, wish OSHA was more involved, and to build on that, I wish the dental boards were more involved. You know, because it'd be so specific to dentistry, uh, it seems like that might help too. But your research is um amazing, and I hope our listeners will take notes. Back to you, Leslie.
SPEAKER_03Thanks, Olivia. So, Dr. Arsenal, what are your understood conclusions? If you can offer those, and um then let's say if there's any other closing thoughts that we have uh surrounding eye safety.
SPEAKER_00Right. So um I think you know, in summary, um, prior to the new Z87.62 standard, the only standard we had was, and these numbers are just they they they're hard to wrap your head around, was called Z87.1. And bloodborne pathogens were not addressed in Z87.1. All they looked at were impact resistance to the eyewear. And and and quite truthfully, in a healthcare field, that's that's a sin because we're dealing with bloodborne pathogens all day long. So, you know, this the new standard came about, Z87.62 addresses bloodborne pathogens, it focuses on bottom gaps, it elevates our standard. And, you know, I look back and and and we always think in life, what what have we done? And so one day when I'm long gone, my hope is that maybe because of this, maybe I save someone's eyes and their vision and their career. And so I think, you know, doing things like this could be considered monumental. Um, it's you know, Z87.62 now, um, it's incorporated into the OSHA standard for what's appropriate. Um, I think we've changed the game. It's a game changer. And um, you know, I'm I'm so thrilled that we're bringing this out. The other the other point I didn't mention in in my words were um the American Dental Association um became aware of this new standard Z87.62, and they did what's known as a direct adopt of this standard. So now it's an ADA standard. And so with that, um, the thing that I'm really excited about is when Coda accredits dental schools, they follow the ADA standards. So now all dental schools need to stay in step with this new ANC Z87.62 standard. Um, and it's it's uh quite interesting. In one of my presentations, I I outlined uh a story and I and I put in a story from a dental student, and he was a newly married student. He was wearing all the appropriate eye and face protection, he was working on an HIV-positive patient, and some of the um bloodborne pathogens came up through somewhere into his eyes. We found out later it was the the bottom gaps. And but this young man being newly married, I mean put a great strain on their brand new relationship. He had to go on a whole cocktail of medicine, and it his his wife actually wanted him to leave the dental profession because she felt very vulnerable and afraid. And so that was a very incredible, stressful time for this young man. He actually was so stressed out he failed a couple of his dental school exams as a result. And um, he was at a crossroads and he almost left the profession. And he was a senior dental student. So I think in, you know, in summary, the new standard is gonna prevent a lot of exposures. Um, it's gonna, you know, help people, it's going to preserve and and and it just up the game in terms in terms of what's appropriate for eye and face protection.
SPEAKER_03Well, thank you so much for that wonderful wrap-up and conclusion. I know for the compliance, David, we will do our very best to push your message out to all of our listeners on the podcast and and also to our own clients. I'm I'm very tempted to send out a newsletter today with information about this podcast and how important it is to pay close attention to this next level of eye care and the bottom gap. And hopefully we can save people's eyes from injury. I I know that when you lose an eyesight in one eye, your depth perception is off. So that's certainly going to make a huge impact on a practitioner's ability to deliver safe care.
SPEAKER_00That's that's awesome. And I I think that's great. The uh interesting, you know, um, you know, we don't want it to end just with the providers because as a provider, um, our responsibility is also to take care of patients. And so now we just recently, and it came out this um month in the Massachusetts Dental Society Journal, um, we published uh research looking at patient eye safety. And interesting, because it's not uh they're not an employee, they're they're not uh covered under OSHA, it's not an occupational safety. So OSHA doesn't mandate any protective eyewear for patients. The CDC recommends it, and dentists should be complying to that. But there's no mandate. So we just have some fresh off-the-press um research, and we did spray studies looking at the patient's eye, and bottom gaps are an issue for patients as well. So if uh anybody wants to look at the journal of the Massachusetts Dental Society Fall, we're also looking at patients because as healthcare providers, we're not only responsible for ourselves or our employees, but also, of course, the patient.
SPEAKER_03Well, that's great information to remind everyone and don't let our patients backpedal on that protective eyewear that we offer them. And if we're not offering it, we should be. Dr. Arsenal, thank you so much for joining us today for the Compliance Divas podcast. And we all want to remind our listeners that we bring clarity and simplicity to compliance by navigating regulations to keep you on course. Please submit your questions to support at the compliancedevas.com and look for the resources that were mentioned today in our show notes. We would love it if you would leave us a review and of course anything you want to mention about Dr. Marcino, we'll pass it along to him as well. Thanks for joining us, and that's it till next time.