By: Alfred L. Frost, III, MS, DDS
published in the NJ AGD Wisdom Journal, Winter 2009 Issue, Volume 6”
What's New With OSHA
The OSHS Act was established in 1970 to ensure that employers furnish their employees both employment and a place of employment which are free from recognized hazards that are causing or are likely to cause death or serious physical harm. Since 1970 there have been no significant changes to what OSHA expects of employers. OSHA regulations are, however, frequently reviewed, refined and interpreted by both an OSHA review commission and by court precedent.
OSHA has the ability under its “General Duty Clause” to cite dentists for violations in which the workplace is not maintained free of hazards to which an employee is exposed and for which a specific regulation or Standard does not exist. In recent years a very significant increase in musculo-skeletal and repetitive motion injuries have been seen in the workplace. As a result, OSHA is now looking at adding a Standard dealing specifically with ergonomics.
A comprehensive review of OSHA is beyond the scope of this article and is usually presented as either a half or full day seminar. We will instead, spend the first portion of this article reviewing the main areas where dentists get into trouble and with which you should already be somewhat familiar. The second portion will be a more detailed look at ergonomics as this is the new “hot button” issue and one with which you may not be well acquainted.
Historically approximately 70% of the citations issued to dentists deal with violations of the Blood-Borne Pathogens (BBP) Standard; 20% deal with violations of the Hazard Communications Standard (Haz Com); while the remaining 10% is inclusive of violations in such areas as gas storage, machine guarding, electrical, etc. Throughout these primary categories citations are most commonly issued in four areas:
• Training of staff in BBP
• Training of staff in Haz Com
• Existence of required written programs
• Record keeping
The BBP Standard is designed to protect employees against exposure to pathologic micro-organisms in blood or saliva which can cause disease in humans including HBV, HCV and HIV among others.
A written Exposure Control Plan (ECP) is required to address the topics of Hazard Determination, BBP and Personal Protective Equipment (PPE) as concerns the elimination or minimization of employee exposures to blood or Other Potentially Infectious Materials (OPIM). The ECP must contain:
• An Exposure Determination
• A discussion of how you will use Engineering Controls (EC) and Work Practice Controls (WPC)
• A discussion of PPE and how you will train your staff in its use
The exposure determination must list tasks and jobs whose performance exposes staff members to blood or OPIM.
In the EC and WPC discussion you must address in detail how you will:
• Use EC and WPC
• Ensure staff usage of PPE
• Provide training and what you will cover during that training, as regards BBP
• Communicate hazards to employees
• Provide medical surveillance and post-exposure follow-ups
• Provide Hepatitis B vaccinations
• Evaluate exposure incidents and what you will do if an exposure occurs
• Use labels and signs
• Handle record keeping
The training of staff with respect to PPE must be conducted live with a person qualified to present the material, demonstrate PPE usage and answer all questions regarding PPE and BBP in general. OSHA frowns on the use of a CD or video tape as a sole training tool. Employees need to demonstrate their understanding of the topic and this can only be accomplished in a live format. Training of staff regarding PPE must include:
• When it is required
• What PPE is needed for each specific task/job
• How to properly don, doff, adjust and wear the PPE
• A discussion of the limitations of PPE
• A discussion of the care, maintenance, useful life and proper disposal of the PPE
Now, let’s briefly turn our attention to Hazard Communications. The employer must take steps to decrease exposures, substitute less hazardous materials (where possible) and establish proper work practices. A written Haz Com program is mandatory and must address three principle topics:
1. Labels and warnings: Here you must identify the chemicals, their manufacturer names and contact information and any hazard warnings associated with them.
2. Material Safety Data Sheets (MSDS): These must be present in the workplace and available so that staff members can read them at any time.
3. Employee information and training: You must provide information and training on hazardous chemicals in the workplace and on protective measures to be taken to prevent exposures.
In addition to being mandatory, written programs which are well executed and define the protocols to be followed in your office are a great way of showing OSHA that you are doing all you can to ensure employee safety. Along with the BBP ECP and the Haz Com programs already discussed, other written programs must be in place and updated as needed. The most significant of these is the Emergency Action Plan (EAP). There are instances where this does not have to be written but I strongly suggest you write it. It is easy enough to do and gives you an additional layer of protection in the event of an incident.
You must determine what “expected” emergencies are relevant to your practice and have a separate plan to deal with each. In lieu of this you may simply maintain a single master plan with contingencies for each emergency. Examples of emergencies might include: fire, medical emergencies, extended power loss, workplace violence, robbery, etc. In the case of fire, for example, your plan might state how you will report the fire, how evacuation is to occur, how staff will be accounted for after the evacuation, etc.
Please note that I always suggest a written EAP as some of the components to be addressed in it, specifically fire prevention and the use of portable fire extinguishers, are always required to be in writing. Lack of properly composed, updated and maintained written programs can lead to significant fines.
Before moving on to the new area of ergonomics I’d like to touch briefly on record keeping. The following is a list of records which must be maintained and the duration of time for which each must be maintained.
• Exposure Records: maintain for duration of employment plus 30 years.
• Employee Medical Records: maintain for duration of employment plus 30 years. If an employee works less than 1 year, you may give them the records at termination and then be exempt from the 30 year maintenance requirement.
• Training Records: maintain for at least 3 years from the last training or update.
• Sharps Log: maintain for 5 years from the end of the year that it covers.
• MSDS: maintain for as long as the chemical is in use plus 30 years.
As I mentioned at the outset OSHA is now seriously scrutinizing musculo-skeletal and repetitive motion injuries occurring in the workplace. These injuries may range from carpal tunnel syndrome or DeQuervain’s tenosynovitis (repetitive motion injuries) in both clinical and clerical staff to neck and back pain or eye injuries in clerical staff working at stations with computer monitors. You should always analyze the various jobs and work tasks and correct deficiencies when noticed. Instruct employees to tell you when they find something physically uncomfortable in their work environment. Look for:
• Awkward postures such as leaning forward to view a computer screen, raising elbows overhead to perform tasks, etc.
• Prolonged repetitive motion such as keyboard use or certain hygiene procedures.
• Contact stress such as repeated contact with the hard edges of a desk, etc.
By way of example: What you should look for at a computer workstation:
• The top of the monitor should be at or just below eye level
• Head and neck should be in vertical alignment with torso
• Shoulders should be relaxed
• Elbows should be close to the body and supported
• Lower back should be supported
• Wrist and hands should be in line with the forearms
• Work surface should have adequate room for keyboard and mouse
• Feet should be flat on the floor
• Complaints of eye fatigue, irritation, blurred vision, headaches, etc.
Correct these deficiencies by:
• Training staff in techniques for proper posture
• Using a rest bar during keyboarding
• Using padding on sharp/firm desk edges
• Using padded arm rests
• Using chairs which provide good lumbar support
• Adjusting monitor light intensity
• Adjusting room lighting, etc.
While far from exhaustive the above should serve as an outline for you to review what you currently are (or are not) doing in your own office. With OSHA a small pro-active effort can prevent serious problems later. Check out your practice and correct deficiencies. If you need any help, give me a call.
Dr. Frost is Vice President for Clinical and Scientific Affairs at Dental Recycling North America, Inc. (DRNA).