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OSHA Requires a Customized Exposure Control…what?

(NOTE: This is a guest article from Sharalyn Fichtl of Dental Quality Assurance, PLLC. We’re sure you will find her qualifications impressive. Her contact info is included. If you need some OSHA or HIPPA assistance, she is the person to call. MG)

Anna is the best dental assistant you could ask for! She’s been with you for 3 years. She’s young and energetic, has a great attitude and is always on time. Which is why you promoted her to lead dental assistant last year. Hygiene school is on her horizon; as soon as her finances will allow it. You attended her wedding last year and thought fondly about how she’s got her whole life ahead of her. Then as a big surprise, she made an announcement at the staff meeting yesterday that she’s expecting her first baby! Everyone was so happy for her and said they thought she seemed to have a special “glow” about her lately. It was a great start to a very busy day. Everyone got into the groove and the patient flow was smooth as glass. Then, someone in the back office said Anna was hurt. She said the dentist had re-capped the used needle but when she twisted it off of the syringe she didn’t realize the needle had bent and poked through the cap. The needle punctured through her glove and into her right thumb. All anyone could think to say was “don’t worry”, “I’ve been stuck before and it was nothing”, “I know people who’ve had several needle sticks” to try to ease her mind. As she vigorously washed and rinsed her hands with soap and water she couldn’t help but be nervous because of the baby. She looks to you for comfort and reassurance that everything will be ok. It was that moment that you got a sick feeling in your stomach; you realized she got hurt at work, most likely exposed to Hepatitis B (God forbid it be anything worse), and the baby….oh man, the baby. What if she gets Hepatitis or HIV? You’re her employer, this happened at work, you have no record of any sharps safety training and seemingly no defense if she decided to sue you for her and the baby’s long-term care. The thought of that article you read from the compliance lady flashed into your mind like salt in a fresh wound. She was telling dentist employers that it was against the law to place an employee in a position of potential exposure to blood-borne pathogens without first offering to pay for their Hepatitis B Vaccine series. Now you just want to curl up in the fetal position in the corner of the room, fall asleep and wake up only to realize it was a horrible dream.

This was no bad dream. This was reality for a dentist that I know. He had not offered his employees the vaccine. He had not trained (or had them trained) annually on sharps safety. He had no customized Exposure Control Plan per the requirements of OSHA. He didn’t know how or when to send her to the doctor. He didn’t know how to document the exposure incident. He didn’t know whether to allow her to continue to work or not. He didn’t know he could interview and ask the source individual (the one the needle was used on for dental treatment) to get tested. He didn’t know whether this incident was going to cause him to get sued. He was very worried and justifiably so. I’m happy to tell you that the employee tested negative for HepB and HIV. It was a wake-up call for the dentist. He decided to re-group and call the lady that wrote the article.

Exposures happen every day in dental healthcare. In dentistry, all that’s needed to expose an employee to blood-borne pathogens is saliva because OSHA says it has a higher risk of containing blood. That blood, that’s in the saliva, can easily enter the employee’s mucous membranes (eyes, nose, and mouth) or blood via needle stick. Some dental providers are more desensitized than others. It’s critical that dentist business owners think past their personal desensitization and be diligent about instilling a general culture of compliance and do those things that lower risk, not raise it.

OSHA requires employers to 1) document (and customize) an Exposure Control Plan (ECP), 2) document annual ECP training, 3) document annual sharps safety training and 4) document offer/declination of Hepatitis B Vaccine (HBV) to their clinical employees within 10 days of their employment at the employer’s expense and 5) follow a particular protocol for post-exposure documentation.

An ECP is a written plan that details the process on what to do if an employee is exposed to blood- borne pathogens. If you’ve ever bought one of those “off the shelf” OSHA manuals there’s probably an ECP in there except that it probably wouldn’t pass an OSHA inspection. For example, a properly drafted ECP will contain the name, address, phone number and travel directions to a specific medical doctor that you pre- arranged to care for your employees in the event of an exposure incident. The MD that you designate must be one that follows the CDC protocol for Employee Exposure Incidents and if you’ve ever put together an ECP you would know that not all medical doctors provide this service. This is why there must be a plan ahead of time and why employees must be trained at least annually on the ECP and Sharps Safety.

HepB vaccines require some employer management. This means some effort toward ensuring the employee gets offered the shots within 10 days as well as making sure the employee doesn’t forget or fail to get all 3 shots (which takes a couple of months) to complete the series. Some employees will elect not to have the vaccine which would entail a simple signature on the HepB Vaccine Declination Form provided by OSHA. If an employee fails to follow through with any of the shots, get that employee to sign the Declination Form. An employee can change their mind and elect to get the vaccine anytime, at the employer’s expense. The cost for the shots are about $20 each at the county health department. Private MDs and corporate clinics are notoriously expensive at $80 or more per shot.

Post-exposure requirements include a written exposure incident report, documentation about the source individual, medical releases from employee and source individual, possible re-training of the employee, possible disciplinary action, possible policy changes or implementation and other things depending on the scenario.

If there’s no ECP, no offer for the vaccine, no management of the process and no employee training how could an employer expect anything more than a weak defense to a lawsuit? Being compliant with OSHA regulations is not only an act of compliance but also an act of risk management. Aside from being a dentist, would you, as the owner of your business, prefer to conduct business in a way that raises your risk for liability? Most would say, no! No business owner should fail to follow OSHA regulations because OSHA exists for the protection of employees. Your employees are watching your every move and their efforts are essential to the progress of your business. My advice to you is to create a culture of compliance starting with the employer- employee relationship and follow all of the OSHA regulations, particularly those spelled out in the Blood-born Pathogens Standard 29 CFR 1910.1030.

Sharalyn Fichtl
Dental Quality Assurance, PLLC (DQA) Owner
469-343-7888 talk or text
972-294-3355 fax
Dental Compliance & Risk Management Professional
Complex Compliance Implementation and Maintenance Processes
Founder of the first-ever dental-only compliance company in Texas
Former Texas State Board of Dental Examiners Investigator
Former State Police Narcotics Trafficking & Prescription Fraud Investigator
Former State Police Highway Patrol Trooper