#3 – Be safe | Dental Practice Coaching

Cart

#3 – Be safe

We want you to be safe while you work in our practice. OSHA has guidelines for all dental practices and we follow them – and we even invite OSHA to come into the practice every 3-5 years to check our work practices and answer questions so that all our staff and dentists are safe. This plan is designed to minimize our staff exposure to blood or other potentially infectious material.

These blood borne pathogens ‑ particularly the human immunodeficiency virus (HIV) that is responsible for AIDS and the hepatitis B virus (HBV) are serious diseases.  This plan, based on recently developed universal precautions, assumes that body fluids (such as saliva and blood) are potentially infective with blood borne pathogens.

This outline of the exposure plan will be kept in General Level I.  A copy of the OSHA Blood borne Pathogens Standard (CFR 1910.1030) is located in _________________________.  You may review it anytime you wish.  Although this document can be difficult to read, you should be familiar with its contents and be in compliance with its requirements.  This manual will be reviewed annually and updated as changes occur.

Each member of the staff falls within one of four categories of employees:

  1. Dentists
  2. Hygienists
  3. Chairside assistant/EFDAs
  4. Secretaries/Business staff

Each category will have a series of training manuals that outline all safety procedures in detail.  These manuals are located ____________________.  Dentists, hygienists, and chairside/EFDA’s are “at risk” and will need to follow strict infection control standards to avoid occupational exposure.  Secretaries are much less exposed to these infectious incidents, and their preventive requirements are correspondingly less stringent. Each employee must be “checked off” on correct, safe approaches to performing each task in their job.  The employee should not enter into any task without an employee already trained helping them practice this task until it is performed satisfactorily. No staff member should ever perform any task that isn’t safe or healthful.  If you have any questions about a particular job, ask your doctor.  This won’t “irritate” your doctor.  It’s our job to try to be aware of all potential hazards here.  Your cooperation in informing us of potential hazards is an important part of your job.

Your health and safety is more important than treating clients.  After all, we’re a “health” facility!  Everyone here must pitch in and cooperate to protect everyone else.  Don’t be shy about questions. Don’t be afraid of “rocking the boat” with your ideas.  We all need to keep our safety in mind constantly. We have never had a serious injury here.  With your help we’ll keep our record clean.

Our safety and health program will include: Providing mechanical and physical safeguards to the maximum extent possible. Conducting a program of safety and health inspections to find and eliminate unsafe working conditions or practices, to control health hazards, and to comply fully with the safety and health standards for every job. Training all employees in good safety and health practices. Providing necessary personal protective equipment and instructions for its use and care. Developing and enforcing safety and health rules and requiring that employees cooperate with these rules as a condition of employment. Investigating, promptly and thoroughly, every accident to find out what caused it and to correct the problem so that it won’t happen again.  Setting up a system of recognition for outstanding safety service or performance.

We recognize that the responsibilities for safety and health are shared: The doctors accept the responsibility for leadership of the safety and health program, for its effectiveness and improvement, and for providing the safeguards required enduring safe conditions.   Senior staff (level 4 and above) are responsible for developing the proper attitudes toward safety and health in themselves and in those lower level staff personnel, and for enduring that all operations are performed with the utmost regard for the safety and health of all personnel involved, including themselves. All staff is responsible for wholehearted, genuine operation with all aspects of the safety and health program including compliance with all rules and regulation ‑and for continuously practicing safety while performing their duties.

Dentistry requires the use of many hazardous materials.  One of your primary responsibilities will be to protect yourself, the rest of the staff, and your clients from the harmful effects of those materials.  The Occupational Safety and Health Administration (OSHA) has established standard 29 CFR 1910.1200 to set guidelines for our safety.  A copy of this regulatory standard is available online at www.osha.gov. You may look at it and/or copy it any time you wish.

We have a 6-step program that you will be expected to follow exactly.

  1. Labeling of all hazardous materials
  2. Be familiar with our material safety data sheets
  3. Be familiar with how the material is used in our office
  4. Learn the definitions of words and phrases used in these articles
  5. What to do if an accident occurs
  6. Signed form by you and dentist

The following information is required on labels:

  1. Chemical or common name of hazardous on labels
  2. Appropriate warning in English
  3. Name and address of manufacturer

Here are some general precautions:

  1. Handle chemicals properly in accordance with manufacturer instructions
  2. Avoid skin contact with chemicals
  3. Minimize chemical vapor in the air
  4. Do not leave chemical bottles open
  5. Do not use flame near flammable chemicals
  6. Do not eat in areas where chemicals are used
  7. When appropriate, wear protective eyewear and masks
  8. Know proper cleanup procedures
  9. Dispose of all hazardous chemicals in accordance with MSDS instructions and applicable local, state, and federal regulations
  10. Never throw away any material safety data sheets that come with materials – give them to your dentist. He will review them to make sure they are complete
  11. Manufacturers MSDS are available by staff lounge in the white notebook labeled “MSDS”
  12. All incoming hazardous materials/chemicals need to be labeled when unpacked
  13.  Every room with an X-ray on the west side is shielded on each wall.  These rooms are restricted areas.  When you expose a film, make sure you are:  At least 6 feet and at a 45 degree angle to X-ray head  and Never in a direct line with the beam (front or back) and Out of room

All labels should contain:

  1. Identity of the chemical
  2. Appropriate hazard warnings
  3. Name and address of manufacturer

GENERAL POLICY

  1. All staff shall follow these safe practice rules, perform safe operations, and report all unsafe conditions or practices to a senior staff/dentists.
  2. All staff observe and obey every rule, regulation and order necessary to the safe conduct of the work, and shall take such action necessary to obtain compliance.
  3. All staff shall be given frequent extensive accident prevention instructions in their training manuals, practice drills, and an annual staff meeting concerning workplace safety and health shall be given.
  4. Anyone known to be under the influence of alcohol and/or drugs shall not be allowed on the job while in that condition.  Persons with symptoms of alcohol and/or drug abuse are encouraged to discuss personal or work‑related problems with the supervisor/employer.
  5. No one shall knowingly be permitted or required to work while his or her ability or alertness is impaired by fatigue, illness, or other causes that might expose the individual or others to injury.
  6. Staff should be alert to see that all guards and other protective devices are in proper places and adjusted, and shall report deficiencies.  Approved protective equipment shall be worn in specified work areas.
  7. Horseplay, scuffling and other acts, which tend to endanger the safety or well being of staff, are prohibited.
  8. Work shall be well planned and supervised to prevent injuries when working with equipment and handling hazardous materials.

Everyone has read about AIDS and Hepatitis.  These are only two of many infectious diseases we may be exposed to.  An exposure can occur in an obvious manner ‑ getting cut by an instrument or some other sharp object that was contaminated by an infected client.  However, you could also be infected by just touching an infected object and then rubbing your contaminated finger over your eye, nose or mouth. Many infected people look perfectly healthy.  The only way to protect yourself is to follow all the guidelines established.

TRAINING

All employees will be provided with training before they begin work involving occupational exposure.  Thereafter, training will be provided at least annually and whenever changes in tasks or procedures require.  Training will be provided during work hours at no cost to the employee by someone who is familiar with the standard as it relates to the dental office

Training will cover:

  • An explanation of the Bloodborne Pathogens Standard and where a copy of the standard is filed (e.g. General information about the epidemiology and symptoms of bloodborne diseases.
  • Modes of transmission of bloodborne pathogens.
  • An explanation of this office’s exposure control plan and how to obtain a copy.
  • How to recognize tasks involving occupational exposure.
  • The use and limits of engineering controls, work practice controls and personal protective equipment. (PPE)
  • Where PPE is located and how to use, remove, handle decontaminate, and dispose of it.
  • How to select appropriate PPE
  • The effectiveness, safety, benefits, and method of administering hepatitis B vaccine and that vaccination will be provided free of charge.
  • What to do if there is an emergency spill of blood or other potentially infectious material.
  • Post‑exposure evaluation and follow‑up that will be made available to employees in case of an exposure incident.
  • The system of labels and color‑coding used in this office to warn employees of biohazards.
  • An opportunity for interactive questions and answers.

 

The employee will maintain a record of all training sessions.  The training record will include:

  • Date of training
  • Contents of training (a summary or list of subjects is sufficient)
  • Name and qualification of trainer
  • Name and job title of each person attending

 

The following exposure determination has been prepared for this office: All employees in the following job classifications have occupational exposure.

Job classification 

chairside assistant

cleaning/sterilization assistant

expanded function personnel

dentists

hygienists

Some employees in the following job classifications have slight occupational exposure, when handling client charts.

Job classification

Receptionist

insurance secretary

public relations coordinator

front desk manager

billing secretary

 

Universal precautions

Universal precautions is an approach to infection control that treats blood and certain body fluids (including saliva in dental procedures) from all patients as infectious for HBV, HIV, and other bloodborne pathogens, regardless of the patient’s perceived infectious status. Universal precautions are one of the most important measures for preventing transmission of bloodborne pathogens.  This office uses universal precautions, and all employees are trained to understand this concept.

Engineering controls isolate or remove a hazard from the workplace.  Examples of engineering controls that might be used in a dental office are sharps containers, rubber dams, and high volume evacuators.  Engineering controls must be examined routinely and maintained or replaced as needed to ensure their effectiveness (e.g., inspecting sharps containers daily to make sure they are not overfilled).  In this office, engineering controls are inspected and maintained by our cleaning/sterilization person and oversight is provided by the clinical coordinator.

Work practice controls

  1. Proper handwashing techniques
  2. Use disinfectant wipes on phones, keyboards, desktops
  3. Don’t eat at your desk
  4. Never leave dirty dishes in sink

Breaks in skin that become infected chemical splashed into eye, or physical injury

Due to the potential of infection, be sure to let a dentist or team leader know if there is any possibility of infection.  Even a small infection can lead to a serious health problem if not treated.

Eating and drinking

Eating, drinking, smoking, applying cosmetics or lip balm, and handling contact lenses is prohibited in where there is a reasonable likelihood of occupational exposure (dental, operatories, laboratory, sterilization area, medical waste storage area). Food and drink may not be stored in refrigerators, freezers, shelves, cabinets, or on countertops or bench tops where mold or other potentially infectious materials are present.  In this office, food and drink may be stored ______________________.

Personal protective equipment (PPE)

The standard defines personal protective equipment (PPE) as specialized clothing or equipment worn by an employee to protect against a hazard.

  1. Radiation
    1. Any area that contains an x-ray should not be entered if an x-ray is being taken.
    2. Even though our walls are lead lined, there is still the danger of radiation accumulation.  Each exposure remains in your system and adds to the accumulated dose from all past radiation exposures.
    3. We take many precautions to protect our clients.
      1. Lead shields
      2. The fastest x-ray film
      3. Long cones
      4. Paralleling devices to reduce the number of retakes
      5. Long cones to reduce scatter radiation.
      6. See a copy of our floor plan that shows the rooms with x-rays
      7. You can read a copy of Ohio’s radiation protection rules that are kept in Dr.Smith’s lateral file under “x-rays.”
      8. Skin irritation cause by wearing latex gloves
        1. Switch to non-latex gloves
        2. Use water based hand lotions
        3. If still a problem, see your general physician

LABELS

In this office, potentially biohazards material are color‑coded red or identified with the following biohazard symbol and the word “biohazard” in contrasting color on a fluorescent orange or orange‑red label.

MEDICAL RECORDS

A confidential medical record is maintained for each employee with occupational exposure.  The medical record includes: The employee’s name and social security number.   A copy of the employee’s hepatitis B immunization status and any of the following that apply: Exposure incident report,  Written opinion of health care professional Form refusing hepatitis B vaccination Form refusing post‑exposure evaluation and follow‑up (not required by OSHA, but highly recommended)

Employee medical records for this office are maintained ___________________________.  Employee medical records are kept confidential and will not be disclosed without the employee’s consent or as required by law.  Employee medical records are retained for the length of employment plus 30 years.

OSHA standard 1910.20 gives employees the right of access to their own medical and exposure records.

Certificate of Hazard Assessment

I, Dr. ___________________ , certify that the dental office was evaluated on _____________ for hazards, which are present, or likely to be present, which necessitate the use of personal protective equipment.

Ergonomics

Most injuries in dental practices can be prevented. Most of these injuries are caused by physical mistakes made repeatedly – a secretary doesn’t sit correctly facing her computer, or a hygienist uses poor hand positions. Watch for these risk factors.

  1. Regular repetitive tasks
  2. Awkward postures
  3. Forceful exertions
  4. Poorly designed work stations
  5. Poor body mechanics

Housekeeping

Even though there is no smoking in the building, fire is always a potential hazard.  All trash should be emptied into bags and placed in the utility room.  The janitorial staff will remove this trash and place it in the shed away from our main building.  All nitrous/oxygen tanks should be chained against the walls.  Not only could the gases ignite, but if a tank fell over, it could explode. Watch out for cords (equipment, telephone, etc.) If you see any that aren’t tied down, tell your team leader.

Tornadoes

If a tornado watch (condition is right for a tornado) is issued, everyone should listen to the local radio station over the intercom system.  If an actual emergency exists (tornado warning –actual sighting in the area), the fire department will activate their siren.  Tornadoes have a ground speed of 30MPH.

Under no circumstances should you exit the building.  The safest location during a tornado is; _______________________________. All staff, clients, and doctors should form along this wall. Bring one of our portable radios so we will know when the all clear has sounded.  Stay away from the utility room and the nitrous/oxygen storage room.  These tanks could explode if they are violently knocked around. Don’t worry about opening any windows.  They will probably break during the tornado anyway! When the siren sounds, get all patients against the safe wall.  Every second counts.  If you have time, grab the first aid box located _________________________ and bring it with you. Ask your dentist for a map of the building that shows exits for emergency exit routes.

Fire Prevention

Work Place Fire Hazards:  Lab area and  Nitrous oxide/oxygen storage area

If a fire occurs we will use 2 approaches – put it out or evacuate the building.

  1. Fight the Fire!
    1. Only small fires – your safety comes first
    2. Let everyone else know there is a fire
    3. Using a portable fire extinguisher
      1. All fire extinguishers are located __________________. Each extinguisher is checked annually to make sure it’s operational. Although the doctors will be primarily responsible for handling the extinguishers, all staff should be familiar with their operation.
      2. Don’t worry about making a mess – put the fire out.
      3. Don’t get too close to the fire
      4. If you aren’t successful and the fire is spreading – leave and the fire department will take  over.
      5. Secretaries should phone 911 to report the emergency and warn the firemen about the nitrous oxide and oxygen tanks next to the utility room.  Exit all clients from the reception room and restrooms.  Be sure to let everyone in the building know that there is an emergency.
      6. Leave the building
        1. Make sure everyone – including clients – knows about the fire/ evacuation – spread the word!
        2. Follow the exit signs
        3. After exiting, meet at the front of the building so we can make sure everyone is accounted for
        4. Take the exit that is closest to you and farthest from the fire.  Also stay away from the exits that are near the N20/O2 tanks.
        5. Prevention
          1. It is good to know what to do when a fire starts.  It’s better if the fire never starts.
          2. Follow all guidelines for flammable and combustible materials.
          3. Never store anything inside the adhesive strips around our furnaces.
          4. Don’t throw used matches in the paper trash.  Wet them and put them in the trash.  Try not to put them in or on rolled up paper.
          5. Keep flammable supplies away from heat sources like autoclaves.
          6. Never light a candle in the office.
          7. Never use a scented plug-in in an outlet in the office.
          8. Never leave a space heater turned on when you are not in the room.

 

Snow EmergenciesWhat is a snow emergency?

According to Ohio law, a sheriff may declare a snow emergency and temporarily close county and township roads when reasonably necessary to preserve public safety. The sheriff may vary the level of warning issued to the public.  To distinguish mere warnings from actual roadway closure, the County Sheriffs in Oho have established different levels of snow emergencies.  You can check on weather/road conditions by calling 511, a free phone service.   For instance, the guidelines established for our County are as follows:

Level 1.  Roadways are hazardous with blowing and drifting snow.  Roads are also icy.  Drive very cautiously.

Level 2.  Roadways are hazardous with blowing and drifting snow.  Only those who believe it is necessary to drive should be out on the roadways.  Contact your employer to see if you should report to work.

Level 3.  All roadways are closed to non-emergency personnel.  No one should be out during these conditions unless it is absolutely necessary to travel.  All employees should contact their employer to see if they should report to work.  Those traveling on the roadways may be subject to being charged with a misdemeanor.

Level 1 and level 2 Snow Emergencies

If you elect to stay home during a Level 1 or 2 snow emergency, despite being asked to report to work, it’s ok.  We don’t want you on the roads when you are afraid.

Level 3 Snow Emergencies

Once a Sheriff has declared a Level 3 Snow Emergency, the roads are closed and anyone (non-emergency) traveling on them is subject to being charged with a fourth-degree misdemeanor.  Stay home. We will send all staff home when a Level 3 snow emergency has been declared.   Usually we know a day in advance when a snow emergency may occur.  You’ll be alerted the day before if possible. Around 6:00 a.m. the doctor that opens will call the opening secretary to decide if the practice should not open or not.  If not, we will delay opening until 10:00 a.m. The opening secretary will call several secretaries and team leaders who will have taken schedules home with them.  They will start a call chain with each team leader calling her team.  We always try to call those further away first.

If the roads are not good and you haven’t heard anything, be sure to call your team leader before you leave for work.  At 9:15am the opening doctor and the opening secretary will discuss road conditions again.  This time if there’s not enough improvement we’ll close until 1:00p.m.  Again the phone chain will be activated, so you should check with your team leader before driving to work. Finally, if we are still closed, the opening doctor and the opening secretary will talk again at 12:00.  This time if the roads aren’t safe we’ll close for the rest of the day.  The phone chain will be activated. Call before coming in.

Watch Video “If Saliva were Red”

                            Doctor to call TL’s – TL’s to call team

Team Leader_______________________________________                     Date_________________________