This can only be determined after an assessment is performed by the practice to identify the hazards. Then the appropriate OSHA Standards can be applied to make it a safe workplace. If you are operating in one of the 28 OSHA-approved State Plan States, for example MN, CA or WA, you must comply with the State's requirements which may be different than those of the Federal rule.
The federal OSHA Standards that typically apply to a dental practice are:
General Duty Clause
Specific standards will be described below, however, it’s important for employers to understand that OSHA can also cite under the following sections which are referred to as the General Duty Clause. They are:
You might say that this is a catch-all solution for OSHA for hazards that may not have a dedicated standard. In the past, OSHA has limited its usage of the General Duty Clause when issuing citations, however, in recent years OSHA has increased issuance of General Duty Clause violations. OSHA must be cautious when using this Clause and a violation under this Clause must meet certain criteria which include:
There are several methods that can be used by OSHA to determine if a hazard was “recognized”. The methods include the following:
Employer knew about the hazard and they could have been made aware of it through:
The most important limitations for OSHA to cite under the General Duty Clause appear to be if the conditions of a serious injury or death are not met and if a specific OSHA standard exists. It should also be noted that the General Duty Clause cannot usually be used to require a stricter requirement than what the standard requires.
Some examples of conditions that could fall under the General Duty Clause are musculoskeletal disorders (MSDs) resulting from hazardous lifting, repetitive tasks, or awkward postures that our work sometimes forces us to do, indoor air quality, and workplace violence. OSHA is attempting to develop an ergonomic standard to deal with MSDs but until there is a standard, employers must still address ergonomic issues in their workplace. Assess your workplace for all hazards and act to protect your workers whether there is a specific OSHA standard.
Chemical Hygiene and the Hazard Communication Standard (HCS)
OSHA’s Hazard Communication Standard was last revised in 2012 when some of the components of the Globally Harmonized System were adopted by OSHA. Some parts of HCS are technical, but the basic concepts are simple. If you use chemicals in your practice, then you must comply with the HCS. This would include having the following:
The HCS covers both physical hazards (such as flammables, corrosives, and harmful dusts), and health hazards (such as irritation, lung damage, and cancer). Most chemicals used in the workplace have some hazard potential, so the HCS will probably apply to every product you use. One difference between this standard and other OSHA standards is that this one is performance-oriented. That means that you have the flexibility to adapt the rule to the needs of your workplace, rather than having to follow specific, rigid requirements. It also means that you must exercise more judgment to implement an appropriate and effective program. This is where things get tricky. A good example of exercising judgment is how you choose to communicate hazards of chemicals to your employees.
Identify Hazardous Chemicals in the Workplace
The standard requires an inventory list of hazardous chemicals in the workplace as part of the written hazard communication program. The list will eventually serve as an inventory of everything for which an SDS must be maintained. In the beginning, however, preparing the list will help you complete the rest of the program since it will give you some idea of the scope of the program required for compliance in your facility.
The best way to prepare a comprehensive list is to dig in and survey the workplace. The broadest possible perspective should be taken when doing the survey. Sometimes people think of "chemicals" as being only liquids in containers. The HCS covers chemicals in all physical forms - liquids, solids, gases, vapors, fumes, and mists - whether they are "contained" or not.
Look around, identify chemicals in containers, including pipes, but also think about chemicals generated in the work operations. For example, dusts and exhaust fumes are all sources of chemical exposures. Read labels provided by suppliers for hazard information. Make a list of all chemicals in the workplace that are potentially hazardous. For your own information and planning, you may also want to note on your inventory list the location(s) of the products within the workplace, and an indication of the hazards as found on the label. Even though this information does not HAVE to be listed, it will save you time and help you with your overall health and safety program.
Employee Information and Training
Information and training are a critical part of the hazard communication program. Employees must be able to identify verbally the hazards of the chemicals that they’re working with. Having SDSs and labeling containers is not enough. Worker training must include learning how to read and understand this information, determine how it can be obtained and used in their own workplaces, and understand the risks of exposure to the chemicals in their workplaces as well as the ways to protect themselves. Each employee who may be "exposed" to hazardous chemicals when working must be provided information and trained prior to initial assignment to work with a hazardous chemical, and whenever the hazard changes. Virtual Safety Training + Assessment
Get education in understanding the new classification, labeling, universal symbols and standardized safety data sheet by taking this online course, Employee Training – OSHA’s Revised Hazard Communication.
Bloodborne Pathogen Standard (BPS)
The BPS can be found on OSHA’s website as regulation 29 CFR 1910.1030. This is a 16-page document that was adopted by OSHA on December 6, 1991 and became effective in 1992. Its purpose is to protect healthcare workers from exposure to potentially infectious items. As stated in an OSHA Fact Sheet on the BPS, “Bloodborne pathogens are infectious microorganisms present in blood that can cause disease in humans. These pathogens include, but are not limited to, hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV), the virus that causes AIDS. Workers exposed to bloodborne pathogens are at risk for serious or life-threatening illnesses.” So, OSHA requires employers who have workers with these risks to comply with the Bloodborne Pathogens Standard. Let’s review the requirements that are set out in the Standard.
Bloodborne Pathogens: Re-examining Your Exposure Controls (Infection Control) for the Dental Environment:
Establish an Exposure Control Plan
This is a written plan that establishes how the employer is going to eliminate or minimize potential occupational exposure to bloodborne pathogens. In order to prepare the exposure determination, the employer must:
The assessment stated in Item 1 above is to be performed by employers to determine where it can be reasonably anticipated that workers encounter blood or other potentially infectious materials (OPIM) while doing their job duties.
The list of job classifications stated in Item 2 above can be a list by job title, such as, dentist, dental assistant, dental hygienist, sterilization coordinator, etc. Safety procedures must also be prepared to identify the procedures that workers must take to protect them from OPIM.
The Hepatitis B vaccine must be offered to workers who may encounter potentially infectious items. In a dental practice this can be the dentist, dental assistance, dental hygienist, and sterilization coordinator. If any other administrative workers would be required to clean treatment rooms after patient treatment, then they would also be offered the vaccine. Workers can refuse the vaccine for any reason. The employer must have the worker sign a refusal but be informed that should the worker change his/her mind in the future, the vaccine will be made available at no cost.
Post-exposure evaluation and follow-up applies to any occupationally exposed worker who experiences an exposure incident. Some examples of exposure incidents in a dental practice would be (1) a needle stick with a contaminated needle, (2) splash or splatter into mucous membranes during patient treatment or when cleaning dirty instruments in preparation for sterilization. When this type of exposure occurs, the employer must offer the evaluation at no cost to the worker. It’s best to stress to workers to notify the dentist immediately of this type of exposure and preferably while the patient is at the practice. The dentist would inform the patient of the exposure and ask the patient to consent to blood testing. The employee is also offered blood testing. The employer must maintain confidentiality of the results of the testing for the worker and for the patient. Postexposure prophylaxis and counseling are a part of this procedure. The incident must be documented.
Update the plan annually
Health and safety programs must undergo review at a minimum annually in order to keep the program up-to-date and addressing current health and safety concerns. OSHA requires that the Exposure Control Plan be reviewed annually.
Workers must be trained upon hire, if changes to their job tasks place them at a risk that is new their job, and annually. Get compliance training.
WATCH INTRO VIDEO TO COURSE - Top 5 Ways to Manage Infection Control:
Emergency Action Planning
Planning for emergency situations allows an employer to identify the types of emergencies that could be encountered in their facility. Examples would be chemical spills, fire, medical, weather, and workplace violence. Here are some questions to ask yourself to help you assess how prepared you are for emergencies:
Here are some emergency conditions to consider:
Ensure that emergency equipment is well-maintained. Some of the items on your maintenance checklist could be:
According to NIOSH more than 70% of American workplaces do not have a formal program or policy in place to address workplace violence. Workplace violence is violence or the threat of violence against workers. It can occur at or outside the workplace. In today’s environment, no workplace is immune to the possibility of workplace violence and employers have legal duty and moral obligation to provide a safe workplace. To prevent loss of life and injuries and to limit financial losses and potential liability, employers should institute policies and procedures to prevent violence from occurring in their workplaces. These policies may include means to identify the potential for violence, procedures to prevent the occurrence of violence and, in the event, prevention fails, and an incident of violence occurs, plans to respond and mitigate further damage.
Workplace Security - Securing Your Workplace for Employee Safety:
Personal Protective Equipment ((PPE)
The OSHA Standards that apply to the selection and use of PPE are:
After the employer has assessed the workplace to identify hazards and found that administrative and engineering controls don’t eliminate or minimize the hazards, then personal protective equipment must be provided. If PPE must be provided, then
Review the PPE requirements and selection at a minimum annually.
OSHA’s Standard 1910.1096 establishes the requirements to protect workers from ionizing radiation. This protection can include the use of personnel monitoring devices and caution signs, labels and signals. The Standard defines a dose as:
“Dose means the quantity of ionizing radiation absorbed, per unit of mass, by the body or by any portion of the body. When the provisions in this section specify a dose during a period, the dose is the total quantity of radiation absorbed, per unit of mass, by the body or by any portion of the body during such period. Several different units of dose are in current use. Definitions of units used in this section are set forth in paragraphs (a)(6) and (7) of this section.”
Exposures in a dental practice are typically measured by Rems. The OSHA definition of a Rem is:
“Rem means a measure of the dose of any ionizing radiation to body tissue in terms of its estimated biological effect relative to a dose of 1 roentgen (r) of X-rays (1 millirem (mrem)=0.001 rem). The relation of the rem to other dose units depends upon the biological effect under consideration and upon the conditions for irradiation.”
When personnel monitoring devices are provided, the employer must make the results available to the workers. Make sure that the workers understand what the results mean.
Radiation laws are also state-specific so the dental practice must consult with the state regarding registration of x-ray equipment and the state’s requirements for worker monitoring.
Dental workers are exposed to Nitrous Oxide (N2O) during administration of this anesthetic gas to patients. Exposures should be minimized to prevent short-term behavioral and long-term reproductive health effects that can be produced by N2O.
NIOSH research has shown controls including System Maintenance, Ventilation and Work Practices can effectively reduce N2O concentrations in dental operations to approximately 25 ppm during analgesia administration, the exposure limit recommended by NIOSH. Uncontrolled exposures to N2O have exceeded 1000 ppm. Learn more about the three methods of control.
OSHA has published a report titled Nitrous Oxide in Workplace Atmospheres (Passive Monitor) that indicates sampling methods for measuring nitrous oxide exposure.
OSHA has published information on their website indicating that approximately 30 million people in the U.S. are occupationally exposed to hazardous noise. As reported by OSHA, this type of loss has been the most prevalent occupational health concern in the U.S. for more than 25 years.
To provide guidance to employers, OSHA has published the following standards regarding monitoring and recordkeeping regarding noise levels:
Naturally exposure to high levels of noise are the cause of permanent hearing loss. Short term exposures to loud noise can cause a temporary change in hearing, however, repeated exposures can lead to permanent tinnitus and/or hearing loss. The effects of hearing loss are numerous. It can create physical and psychological stress, reduce productivity, interfere with communication and concentration, and contribute to workplace accidents and injuries when it’s difficult to hear warning signals.
OSHA directs in their standards that an employer must conduct noise monitoring or measuring only when exposures are at or above 85 decibels (dB). So how do you know whether the noise levels in your workplace are above 85 decibels? Consider these questions:
There are two ways to measure noise. It is measured in units of sound pressure levels called decibels using A-weighted sound levels (dBA). OSHA has set legal limits for noise exposure in the workplace. These limits are based on a worker’s time weighted average over an 8-hour day. The permissible exposure limit (PEL) established by OSHA is 90 dBA for all workers for an 8-hour day. NIOSH recommends exposures to noise be controlled below a level equivalent to 85 dBA for 8 hours to minimize occupational noise induced hearing loss.
Injury and Illness Recordkeeping
All employers covered by OSHA must comply with Part 1904 regulations. However, most employers do not have to keep OSHA injury and illness records unless OSHA or the Bureau of Labor Statistics (BLS) informs them in writing that they must keep records. For example, employers with 10 or fewer employees and business establishments in certain industry classifications are partially exempt from keeping OSHA injury and illness records.
To determine if you are exempt because of size, you need to determine your company's peak employment during the last calendar year.
However, as required by § 1904.39, all employers covered by the OSH Act must report to OSHA: (1) within 8 hours any workplace incident that results in a fatality, and (2) within 24 hours an amputation, loss of an eye, or the hospitalization of an employee. State plans may differ from this Federal requirement so consult your state OSHA plan for the exact reporting requirements.
OSHA’s electronic tracking and submission requirements also apply to certain employers:
If employers in State Plan states have questions about their obligation to submit injury and illness information, please contact your State Plan office.
OSHA is paying attention to safety around walking and working surfaces, therefore, the employer must act to prevent slips, trips, and falls. Electrical safety must also be addressed to ensure that workers are not exposed to electrical hazards.
Top 5 Safety Compliance Issues Employers Need to Know:
Not having a health and safety program would be a risk as it creates a chance of loss, danger or injury. Assessing the hazards would be looking for any source of potential damage, harm or adverse health effects on something or someone. Get Virtual Safety Training + Assessment.
The first step is to identify the hazards that exist in your practice. These are the typical types of hazards that may exist in a dental practice:
Conduct a survey of your practice with the above hazards in mind. The survey can be conducted by:
Document your findings and then review the findings again with your employees to see if there is anything else they think should be added to the list. After the list is complete, begin the process of assessing the control measures that have been implemented in your practice to protect employees. These would include administrative controls, engineering controls, and the use of personal protective equipment. If enough control measures have not been put into place, then determine what needs to be done to protect your employees from the hazard.
Establish a timeline for correcting the unsafe practices. Ensure that any changes are incorporated into the written health and safety program documentation. Training of employees will be critical to the implementation of control measures. This is particularly important if the new control measures require a change from the way things have been done in the past. Seeking input from employees on how to correct these issues helps get their buy-in on the changes.
Determine how often this type of assessment will be conducted. At a minimum it should be annually.
Step One: Have the knowledge of OSHA Standards
Employers can begin the process of developing their health and safety program by having a qualified person trained in hazard recognition conduct a thorough safety assessment of the workplace. Discuss with the Safety Coordinator if they need additional training and knowledge about health and safety in the workplace and make a plan of action to assist that individual gain the knowledge needed. There’s nothing worse than being responsible for something you don’t understand yourself.
There are many resources available for this step. They include:
Step Two: Perform a hazard assessment
Conduct an assessment of the hazards in your workplace. These could be chemical, biological, machinery, environmental, and/or physical. This assessment should look particularly at any new hazards that have been introduced into the workplace in the past year. This might include the purchase of new x-ray equipment, adding laser dentistry, or instituting sedation procedures.
Step Three: Take steps to eliminate or minimize hazards.
For each hazard identified, steps must be taken to eliminate or minimize them. OSHA directs to use administrative controls, engineering controls, and the use of personal protective equipment. An example of an Administrative Control would be changing the way a task is performed or removing the risk from the work area. An example of a typical engineering control used in dental practices is providing safe devices for recapping needles. If neither of these controls (administrative and engineering) eliminate or minimize the hazard, then personal protective equipment must be provided.
Step Four: Write programs
Many of OSHA’s Standards require written programs so it must be determined how the hazards that have been identified can be addressed in written programs. Some examples of written programs are:
The programs you develop will recognize the hazards and describe how they are being controlled to protect workers.
Step Five: Train workers
OSHA requires training of workers upon hire, when changes occur in the workplace that require training, and in some cases annually. This link is to the OSHA guidance on training requirements. Review the General Industry section of the publication - Training Requirements in OSHA Standards. Also, if the dental practice is located in a state with a state OSHA plan, check on the training requirements as they can be more stringent than the Federal OSHA requirements.
Training must be conducted by individuals knowledgeable about the subjects of the training. Information and materials provided by outside sources can be used in the training along with videos, online courses, or webinars, however, the training must be specific to the dental practice. For instance, when emergency action planning is being covered, it’s important to discuss the location and use of the emergency equipment in place in the practice along with evacuation and severe weather gathering places.
Some examples of Training requirements are:
Always document the training activities. The Training Register should contain the date and time of training, name and qualifications of the trainer, subjects covered, names and signatures of attendees. Retain these records for your Bloodborne Pathogen training for a minimum of three (3) years. Other training records should be retained according to your policies, however, as a Best Practice it could be three (3) years.
Employee Health and Safety in the Dental Clinical Environment:
Step Six: Evaluate the safety program
In recent years, OSHA has become more inquisitive during inspections about how the effectiveness of the safety program is measured. The employer must be prepared to not only explain this process, but show documentation that the health and safety program is being reviewed and where needed it’s revised.
The most likely response to this inquiry may be that there have been minimal or no work comp claims. This is fine and good, however, there’s more to this than work comp. Develop a thorough system for evaluating the effectiveness of your safety program which should include documentation of those efforts.
Your evaluation could include the following:
Employers must communicate workplace hazards to employees and instruct them on how to protect themselves from injury or illness. Workplace safety training should include all company safety policies.
The objectives of safety training are:
Training should be presented in a way that all employees can understand. If employees have a disability or language barrier then employers should customize training for that worker.
After training activities, an employer should test employees to demonstrate employee retention of the information in order to evaluate the effectiveness of the training. As an employer, you need to evaluate your safety program regularly to determine if additional training is needed to improve your workers’ safety and health. As an employee, you need to inform your employer if you feel you need additional training on the hazards in your workplace.
All workplace safety training must be documented. Bloodborne Pathogen training must be kept on record for a minimum of 3 years. Other safety records should be retained according to your internal policies.
The employer benefits greatly from workplace safety training.
Most importantly workplace safety training helps ensure workers go home safe to their families.
The National Institute for Occupational Safety and Health (NIOSH) describes a 7-Step process for safety training. The steps are:
Step 1—Determining if Training Is Needed
Step 2—Identifying Training Needs
Step 3—Identifying Goals and Objectives
Step 4—Developing Learning Activities
Step 5—Conducting the Training
Step 6—Evaluating Program Effectiveness
Step 7—Improving the Program
Following these guidelines will assist in setting up an effective training program.
Certain OSHA Standards have specific training requirements that employers must fulfill. Let’s look at these individual standards and review the frequency of the training:
Hazard Communication Standard (chemical hygiene)
Upon hire, when new hazards enter workplace
Bloodborne Pathogen Standard (Exposure Control Plan and Infection Control)
Upon hire, when new hazards enter workplace, annually
Personal Protective Equipment
Upon hire, when new PPE is required
Emergency Action Plan
Upon hire, when new emergency equipment is provided, when plan changes
Upon hire, when type of respirator changes, annually
Upon hire and when new equipment is installed
Upon hire, annually
Upon hire, as needed
Walking and Working Surfaces (slips, trips, falls)
Providing training in various ways can be more effective than using one method. Here are some suggestions:
Lectures seem to be the least effective type of training because employees get distracted and in many cases bored. Combining a lecture with a hands-on activity or demonstration can liven up the training session. In our experiences at SafeLink Consulting, employees always comment on the “fun” activities that we incorporate into our safety training sessions. We want them to look forward to next year’s training and not dread the safety training each year.
OSHA requires that the training be specific to the employer’s workplace. This eliminates solely using a webinar or online course for training. These venues can be used as a supplement to your onsite training.
The knowledge of the instructor is also important since OSHA requires that employees must be able to ask questions and have them answered by someone with the knowledge. It’s also a plus if the instructor is energetic and knows how to engage the employees in the training. This certainly helps employees stay focused on the training and retain the information.
Review training records and workplace safety policies and programs to ensure their effectiveness. Make a plan of action to improve the training program if workers are having difficulty understanding how to apply your safety program to their job. Review your safety policies to ensure they are covering any new technology being used or other new processes in place in your facility.
Employee Health and Safety in the Dental Clinical Environment:
Infection Prevention Coordinator Training:
Are safety rules enforced the same as attendance, punctuality, accuracy of work, etc.? If not, they should be. Review your constructive discipline procedures and include violations of the safety policies in the same manner.
Is management setting the tone for how safety will be received and complied with in the dental practice? If the employees see their managers not following safety policies, not wearing the required PPE, or not enforcing the safety policy, then it will be very difficult to cultivate safety compliance. Management must lead by example.
Is safety a team effort where one employee can remind another employee to wear their face mask correctly, for instance? Managers can’t constantly monitor the use of personal protective equipment or the use of other safety tools, but should remind employees to follow the safety policies when they are not. Employees should feel okay about reminding each other when a safety policy is not being followed. Safety is everyone’s job. Reminding employees in safety training sessions that safety is an important part of the culture in the practice helps to make this a team effort.
How engaged are the employees in resolving safety concerns? During the year ask for employee feedback which is an important tool when cultivating safety compliance in your workplace. However, employers should only use this process if they plan to follow-up on correcting the employees’ concerns and recommendations. Asking employees for their opinion/thoughts and then not ever using their suggestions will hamper employee involvement.
Employers can interview employees and:
In the Centers for Disease Control’s 2016 Summary of Infection Prevention Practices in Dental Settings, CDC recommends appointing an Infection Prevention Coordinator who performs frequent inspections of the infection control practices. Assessing these practices more than annually provides an opportunity to close the gap more frequently on unsafe infection control practices. This goes for all of the safety policies.
Employers should communicate to employees the importance of reporting Incidents and Near Misses. This information can be extremely helpful in identifying hazards and where better controls need to be implemented or workers need additional training. Incident or near miss investigations would include the following:
The practice should appoint a Safety Coordinator who has the responsibility for planning, implementing and overseeing the dental practice’s employee safety at work. Their main duty is to ensure that the practice is in compliance and adheres to OSHA standards to reduce work-related injuries. The right person should be selected for this position. They should be knowledgeable of the OSHA standards that apply to the dental practice, but also respected by co-workers and perceived as helpful rather than demanding.
Safety doesn’t lie in the hands of one person. The culture of your practice should include the importance of providing a safe and healthy work environment not only for employees but for patients as well.
Watch Intro video - How to Cultivate Safety Compliance:
HIPAA Employee Need to Know:
I have been using SafeLink Consulting’s safety and privacy services since I purchased my practice. My major concern initially was about any safety liability I might be inheriting. The initial risk assessment helped me identify the areas where I needed to focus efforts to ensure a safe environment for my patients and my staff. The relationship that I’ve developed with SafeLink has been invaluable and they are an ongoing part of my staff safety training and program maintenance. They are professional, knowledgeable about dentistry, and provide a quick response to my safety and HIPAA needs.
M. Sajid, DDS Atlanta, GA
A huge thank you for making our OSHA training so stress-free and pleasant! Everyone agreed your presentation was probably one of the best we’ve ever had. And they’re a tough crowd!
Julie B., Office Manager Dental Practice in Loganville, GA