About the AuthorSheila Dunn, DA, MT (ASCP), holds a doctoral degree in clinical laboratory science from the Catholic

University of America in Washington, DC. She has helped thousands of outpatient medical facilities comply

with federal regulations such as CLIA and OSHA through her presentations at a nationwide seminar series.

She has written more than 150 articles about regulatory issues and healthcare delivery systems and serves

as an advisor to numerous companies.

10C

©2005–2010. HCPro, Inc. All rights reserved, including right of reproduction. The author(s) and their agent(s) have made every reasonable effort in the preparation of this publication to ensure the accuracy of the information. However, the information in this book is sold without warranty, either expressed or implied. The authors, the editors, their agents, and the publishers will not be liable for any damages caused or alleged to be caused directly, indirectly, incidentally, or consequentially by the information in this publication. This publication cannot and does not provide specific information for a user’s exact situation. Users of this publication should exercise their own judgment and, where appropriate, seek the assistance of legal counsel regarding their particular situation.

HCPro, Inc.P.O. Box 1168

Marblehead, MA 01945Tel: 800/650-6787Fax: 800/639-8511

www.hcmarketplace.com

OSHAPROGRAMMANUALfor Dental Facilities

OSHA Program Manual for Dental Facilities is published by HCPro, Inc.

Copyright © 2010 HCPro, Inc.

All rights reserved. Printed in the United States of America. 5 4 3 2 1

ISBN: 978-1-60146-744-7

No part of this publication may be reproduced, in any form or by any means, without ¬prior written consent of HCPro, Inc., or the Copyright Clearance Center (978/750-8400). Please notify us immediately if you have received an unauthorized copy.

HCPro, Inc., provides information resources for the healthcare industry.

HCPro, Inc., is not affiliated in any way with The Joint Commission, which owns the JCAHO and Joint Commission trademarks.

Sheila Dunn, DA, MT (ASCP), AuthorDavid A. LaHoda, Managing EditorOwen MacDonald, Executive EditorEmily Sheahan, Group PublisherMike Mirabello, Senior Graphic ArtistMatt Sharpe, Production SupervisorJean St. Pierre, Director of Operations

Advice given is general. Readers should consult professional counsel for specific legal, ethical, or clinical questions.

Arrangements can be made for quantity discounts. For more information, contact:

HCPro, Inc.P.O. Box 1168Marblehead, MA 01945Telephone: 800/650-6787 or 781/639-1872Fax: 781/639-2982E-mail: customerservice@hcpro.com

Visit HCPro at its World Wide Web sites:www.hcpro.com, www.hcmarketplace.com

02/201021752

i

Important Information About the Use of This Program

This product is intended for use in one facility and is copyrighted for this purpose. Please do not copy the con­tents or print additional copies for use in other facilities or for teaching anyone other than your em ployees. This manual may not be transferred to another workplace without the written consent of HCPro, Inc.

As an OSHA Program Manual owner, you may call or e­mail us anytime you have OSHA­related ques tions specific to your practice. HCPro also publishes a monthly newsletter, Medical Environment Update, to help youkeep your OSHA Program Manual current from year to year. Should OSHA pass a revised or new regula tion, we will inform you of that change through Medical Environment Update. We will also provide forms, in structions, posters, and advice through this newsletter to help you keep your practice up to date and in compliance.

Follow these steps to determine if your manual is up to date:1. Check for the three­character code in the lower right­hand corner of the box on the title page of

this manual.

2. Then log into your HCPro account on your Medical Environment Update subscription page at www.hcpro.com/login-3265. If you have not established a username/password or have forgotten it, you may retrieve by clicking the link on this page.

3. Once logged in to the Medical Environment Update subscription page, find the most recent issue.

4. There you will find an update file. If the file has the same code as on the title page, your manual is up to date.

5. If the update code is different, open the file and chose from the appropriate pdf to download for your manual (medical or dental).You also have the choice of printing your update pages one­sided or two­sided, depending you your printing capabilities.

6. Print the updated pages and replace the old pages.

Should you have difficulty logging in or accessing the updated pages, contact HCPro customer service: Telephone: 800/650­6787

E­mail: customerservice@hcpro.com Once again, thank you for your business. Let us know how we can help.

David A. LaHodaManaging Editor

HCPro, Inc.P.O. Box 1168

Marblehead, MA 01945Telephone: 800/650­6787

Fax: 800/639­8511www.hcmarketplace.com

ii

How to Customize this Program

To come into complete OSHA compliance, the information in this program must be customized to reflect the actual circumstances in your workplace. For easy tracking, initial and date when you complete an item.

Item Initials Date

Post the “It’s The Law” poster in a place that is visible to all employees. This poster, OSHA #3165, is located in the front pocket of this manual.

↓

Hang the eyewash station sign located in the front pocket of this manual. Make sure it is clearly visible above or next to the eyewash.

↓

Designate the evacuation route, and post in several locations. Be sure to post the route in the reception area and break room. See Tab 3, page 3­18, 3­18A for details.

↓

Read each tabbed section and verify that the policies and procedures described apply to your practice.

↓

Remove or strike through any procedure

you don’t perform!

ix

IntroductionImportant Information About the Use of this Program .............................. iHow to Customize this Program for Your Workplace ................................ iiWhat is Included in this Program ................................................................ vi

TAB 1: What is OSHA?A Quick Look at OSHA .................................................................................. 1-1

States with OSHA-Approved Plans ......................................................................................1-1OSHA Consultative Services Division ..................................................................................1-2OSHA’s Jurisdiction ..............................................................................................................1-2OSHA’s General Duty Clause ..............................................................................................1-2

Employee or Employer? ............................................................................... 1-3Employer Responsibilities Under OSHA ..............................................................................1-4

Overview of OSHA Standards ...................................................................... 1-5OSHA Inspections ......................................................................................... 1-5

Employee Complaints ..........................................................................................................1-5If an On-Site OSHA Inspection Occurs ................................................................................1-6During the Inspection ...........................................................................................................1-7What OSHA Inspectors May Ask Employees .......................................................................1-7The Typical OSHA Inspection ...............................................................................................1-8The Closing Conference .......................................................................................................1-8

OSHA Sanctions ............................................................................................ 1-10Whistleblower Protection ............................................................................. 1-12

OSHA PROGRAM MANUAL

Contents

Front Pocket OSHA Poster 3165: IT’S THE LAW! Laminated Eyewash Station Sign 4 Sample Biohazard Self-Adhesive Labels CD-ROM (MS Word for Windows 2000) with Master Record Forms (Tab 8) from this Manual

for Customization.

Page

x

Contents

TAB 2: Injury & Illness Prevention ProgramKey Contacts for the OSHA Safety Program ........................................................................2-2Location of the OSHA Safety Program .................................................................................2-2

Duties of the OSHA Safety Officer ............................................................... 2-2Accident/Incident Investigation & Reporting Procedure ........................... 2-3

Definition of an Accident and/or Incident ..............................................................................2-4When to Investigate an Accident/Incident ............................................................................2-4How to Document an Accident/Incident................................................................................2-4Correcting Unsafe Conditions ..............................................................................................2-4

Recordkeeping Requirements ..................................................................... 2-5Equipment & Facility Records ..............................................................................................2-5Bloodborne Pathogens Records ..........................................................................................2-5Hazard Communication Records .........................................................................................2-5Employee Medical Records ..................................................................................................2-6Evaluating Exposure Incidents .............................................................................................2-6

Workplace Hazard Analysis ......................................................................... 2-7Employee Training ........................................................................................ 2-8

Checklist for an Effective Safety Training Session ...............................................................2-8Interactive Safety Training Exercises ...................................................................................2-9

General Safety .............................................................................................................2-9Fire Safety ....................................................................................................................2-9Bloodborne Pathogens Safety .....................................................................................2-10Chemical Safety ...........................................................................................................2-10TB Safety .....................................................................................................................2-10

Annual Employee Retraining ....................................................................... 2-10Bloodborne Pathogens Annual Training Contents................................................................2-11Hazard Communication Annual Training Contents...............................................................2-11

New Employee Orientation ........................................................................... 2-12Documenting Employee Training ................................................................ 2-12

OSHA Yearly Retraining .......................................................................................................2-13

Practical Ideas for Administering the OSHA Safety Program ................... 2-17Organizing OSHA Compliance Duties ......................................................... 2-18

Monthly Facility Review Checklist ........................................................................................2-19Annual Facility Review Checklist ..........................................................................................2-20Annual OSHA Safety Program (Exposure Control Plan) Review Form ...............................2-23

xi

Contents

TAB 3: General Facility SafetyKeeping Employees Safe ............................................................................. 3-1

Important Phone Numbers & Contacts.................................................................................3-1Emergency Phone List .........................................................................................................3-2

Fire Safety ...................................................................................................... 3-3Automatic Sprinkler Systems ...............................................................................................3-3Fire Alarms ...........................................................................................................................3-3Fire Procedures: Immediate Actions ....................................................................................3-3Building Evacuation ..............................................................................................................3-4Fire Extinguishers .................................................................................................................3-4

Purchase the Right Extinguisher ..................................................................................3-5How Many Fire Extinguishers to Have & Where to Put Them .....................................3-6How to Use a Fire Extinguisher: The “PASS” Technique .............................................3-6When to Extinguish Fires with a Portable Fire Extinguisher ........................................3-6

Fire extinguisher supplement ...................................................................... SupplementWhen NOT to Extinguish Fires and to Evacuate ..........................................................3-7Fire Extinguisher Inspections .......................................................................................3-7Fire Extinguisher Maintenance .....................................................................................3-7

Fire Drills ..............................................................................................................................3-7

Electrical Safety ............................................................................................ 3-8Physical Characteristics of a Safe Dental Facility ..................................... 3-8

Air Quality .............................................................................................................................3-8Mold .............................................................................................................................3-9

Mold Remediation ................................................................................................3-10Aisles ....................................................................................................................................3-11Emergency Lighting ..............................................................................................................3-11Employee Dress Code .........................................................................................................3-11Exits, Means of Egress .........................................................................................................3-11Exit Doors .............................................................................................................................3-12Exit Signs .............................................................................................................................3-12Floors ...................................................................................................................................3-13Lighting .................................................................................................................................3-13Noise ....................................................................................................................................3-13Restricted Access Areas .......................................................................................................3-14Sinks .....................................................................................................................................3-14Storage .................................................................................................................................3-14Dental Lab Equipment ..........................................................................................................3-14Air Compressors ..................................................................................................................3-14

Systems Failure ............................................................................................. 3-15Evacuation Plan ............................................................................................ 3-15

Evacuation Procedures ........................................................................................................3-16Evacuation Route .................................................................................................................3-17

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Contents

Emergency Preparedness Supplies ............................................................ 3-19Emergency Action Procedures .................................................................... 3-19

Bioterrorism: Suspicious Letters or Packages ......................................................................3-19What is a “Suspicious Package”? ................................................................................3-19

Bomb Threat .........................................................................................................................3-20If You Discover a Bomb or a Suspicious Item ..............................................................3-20Explosion ......................................................................................................................3-20

Civil Disturbance ..................................................................................................................3-21Earthquake ...........................................................................................................................3-21

If a Tremor Occurs when You Are Inside ......................................................................3-21After the Tremor Is Over ...............................................................................................3-21

Severe Weather ...................................................................................................................3-22Flood ............................................................................................................................3-22Hurricane ......................................................................................................................3-22Severe Thunderstorm or Tornado Warning ..................................................................3-22Tornado Safety Tips .....................................................................................................3-23Severe Thunderstorm or Tornado Watch .....................................................................3-23Toxic External Atmosphere ...........................................................................................3-23

Violence ................................................................................................................................3-23Violence Prevention Plan Introduction .........................................................................3-23Overview of Violence Prevention Plan Components ....................................................3-23

Part 1 ...................................................................................................................3-24Part 2 ...................................................................................................................3-30

More Sources for Prevention of Workplace Violence ...................................................3-31

First Aid .......................................................................................................... 3-31First Aid Kit ...........................................................................................................................3-31Basic First Aid for Common Emergencies ............................................................................3-32Crash Kit/Cart Components ................................................................................................3-34

Drug-Free Workplace Program .................................................................... 3-36Service Animals ............................................................................................. 3-41Holiday Decorations ..................................................................................... 3-43

Sample Checklist: Spot Check Your Facility’s Holiday Decorations .....................................3-43

Safe Decorations and Displays Policy ........................................................ 3-45

TAB 4: Ergonomics in the Dental WorkplaceA Quick Look at Ergonomics ....................................................................... 4-1Identifying Ergonomic Stressors ................................................................. 4-2Common Musculoskeletal Disorders .......................................................... 4-3

Repetitive Stress Injuries/Wrist Injuries ................................................................................4-3Eye Strain .............................................................................................................................4-4

Why Prevent CVS ........................................................................................................4-5

xiii

Contents

Symptoms of CVS ........................................................................................................4-5Other Suggestions for Relieving Eye Strain .................................................................4-6

Back Injuries .........................................................................................................................4-6Fatigue .................................................................................................................................4-6

Selecting Ergonomically Sound Equipment ............................................... 4-7Ergonomically Sound Work Strategies ....................................................... 4-8Ergonomics Resources ................................................................................ 4-8

TAB 5: Bloodborne Pathogens Exposure Control PlanExposure Control Plan Introduction ........................................................... 5-1Overview of Bloodborne Pathogen Standard Components ...................... 5-2A Quick Look at Occupational Exposure .................................................... 5-3Key Provisions and Effective Dates ............................................................ 5-3Universal Precautions .................................................................................. 5-3

Other Potentially Infectious Materials (OPIM) ......................................................................5-4Implementing Universal Precautions ....................................................................................5-4

Bloodborne Pathogens ................................................................................. 5-5Epidemiology of Bloodborne Pathogens ..............................................................................5-5Update on AIDS in the Workplace ........................................................................................5-8Transmission of Bloodborne Pathogens ..............................................................................5-9

Exposure Determination ............................................................................... 5-9Personnel Who Are Occupationally Exposed .......................................................................5-9

Exposure Prone Procedures ........................................................................................5-9Bloodborne Pathogens Exposure Determination List #1 (Form 8) .......................................5-11Other Personnel Who Could Potentially Be Occupationally Exposed ..................................5-12Employees Who Are Not Occupationally Exposed...............................................................5-12Bloodborne Pathogens Exposure Determination List #2 (Form 9) .......................................5-13

Restricted Access Areas .............................................................................. 5-14Engineering/Work Practice Controls ........................................................... 5-14

Biohazard Labels ..................................................................................................................5-15Handwashing ........................................................................................................................5-15

When to Wash Hands ..................................................................................................5-16How to Wash Hands ....................................................................................................5-16Artificial Nails ................................................................................................................5-17

Sharps Safety .......................................................................................................................5-17What to Look for in Safety Devices ..............................................................................5-18Sharps Evaluation Procedure ......................................................................................5-18Use of Non-Safe Sharps ..............................................................................................5-19

Sharps Containers ................................................................................................................5-20Sharps Container Maintenance ....................................................................................5-21Sharps Container Disposal Procedure .........................................................................5-21

Servicing or Shipping Contaminated Equipment ..................................................................5-21Decontaminating Work and Touch Surfaces ........................................................................5-21Sample Housekeeping Schedule .........................................................................................5-23

xiv

Contents

Spill Containment Plan ................................................................................. 5-24Spill Cleanup Procedures .....................................................................................................5-24Spills that Contain Broken Glass or Sharp Objects ..............................................................5-24

Instrument Sterilization and Disinfection ................................................... 5-25Transport and Precleaning ...................................................................................................5-25When to Sterilize ..................................................................................................................5-25

Sterilization ...................................................................................................................5-26Quality Checks for Sterilization ....................................................................................5-26

High-Level Disinfection ................................................................................ 5-27Keeping Employees Safe during Instrument Disinfection ....................................................5-27Sterilants/High-Level Disinfectants .......................................................................................5-28

Decontamination ........................................................................................... 5-29Decontaminating Semi-Critical Equipment ...........................................................................5-29Decontaminating Non-Critical Patient Care Equipment .......................................................5-29Decontaminating Personal Protective Equipment (PPE) .....................................................5-29

Eyewashes ..................................................................................................... 5-30Number & Placement of Eyewash Stations..........................................................................5-30Eyewash Maintenance .........................................................................................................5-31

Eyewash Checks ..........................................................................................................5-31

Waste Disposal .............................................................................................. 5-31Biomedical Waste Disposal ..................................................................................................5-31Hazardous Waste Disposal ..................................................................................................5-32Waste Handling & Storage ...................................................................................................5-33Laundry ................................................................................................................................5-33

Personal Protective Clothing & Equipment ................................................ 5-34Gloves ..................................................................................................................................5-35

When to Wear Gloves ..................................................................................................5-36How to Wear Gloves ....................................................................................................5-36Latex Allergy .................................................................................................................5-37Preventing Allergic Reactions ......................................................................................5-38

Face Protection ....................................................................................................................5-38Body Protection ....................................................................................................................5-38Emergency Resuscitation Equipment ..................................................................................5-40

Hepatitis B Vaccine ....................................................................................... 5-40Safety of the Hepatitis B Vaccine .........................................................................................5-41Documenting Employee Hepatitis B Vaccinations ................................................................5-41Titering Employees after the Hepatitis B Vaccination ...........................................................5-42

How to Determine Employee Immunity ........................................................................5-42Testing Employees Vaccinated before the Titer Requirement ......................................5-43

Types of Hepatitis B Tests ............................................................................ 5-43Interpreting Hepatitis B Test Results ....................................................................................5-44

Post-exposure Evaluation & Follow-up ...................................................... 5-45What Is an Exposure? ..........................................................................................................5-45What to Do after an Occupational Exposure ........................................................................5-45

When to get Expert* Consultation for HIV Post-exposure Prophylaxis ........................5-50Confidentiality of Post-exposure Procedures .......................................................................5-50Employee Counseling/Precautions .....................................................................................5-51

xv

Contents

Occupational Exposure Management Resources ...................................... 5-51Accident Report/Sharps Injury (Form 11) .................................................... 5-52Post-exposure Checklist (Form 14) ............................................................. 5-54Post-exposure Medical Evaluation Declination Form (Form 15) ............... 5-55Injection Safety .............................................................................................. 5-57

Information for Providers ......................................................................................................5-57Unsafe Injection Practices and Disease Transmission.........................................................5-58

Frequently Asked Questions: Injection Safety FAQs for Providers ......... 5-58Overview ..............................................................................................................................5-58Injection Procedures .............................................................................................................5-59Resources ............................................................................................................................5-62

Infection-Control and Safe Injection Practices to Prevent Patient-to-Patient Transmission of Bloodborne Pathogens ..................... Supplement

Bloodborne Pathogens Resources ............................................................. 5-63Bloodborne Pathogens Violations in Dental Practices ............................. 5-64

TAB 6: Hazardous Chemical & Radiation SafetyA Quick Look at HazCom,, ............................................................................ 6-1

Determining Which Chemicals Are Hazardous ....................................................................6-1Routes of Exposure to Hazardous Substances....................................................................6-2

Material Safety Data Sheets ......................................................................... 6-2Examples of Substances Requiring MSDS ..........................................................................6-2Substances Not Requiring MSDS ........................................................................................6-3Information Required on MSDS ...........................................................................................6-4How to Get MSDS ................................................................................................................6-4Where to Keep MSDS ..........................................................................................................6-4HazCom Recordkeeping ......................................................................................................6-5

Classification of Hazardous Substances .................................................... 6-5Flammable & Combustible Liquids .......................................................................................6-5

Storage of Hazardous Substances .............................................................. 6-6Special Hazard Communication Requirements for California ..............................................6-6

Hazardous Chemicals with Permissible Exposure Limits (PEL) .............. 6-7Avoiding Overexposure to Hazardous Chemicals ................................................................6-7

Beryllium-Containing Alloys ..........................................................................................6-7Glutaraldehyde .............................................................................................................6-8Sterilant Safety Supplement .........................................................................................SupplementGlutaraldehyde Spills ...................................................................................................6-10Testing the Potency of Glutaraldehyde ........................................................................6-10

xvi

Contents

Disposing of Glutaraldehyde ........................................................................................6-10Mercury ........................................................................................................................6-11Nitrous Oxide ...............................................................................................................6-12Silica .............................................................................................................................6-12

Monitoring Employees for Exposure ....................................................................................6-12

Labeling Hazardous Substances ................................................................. 6-13NFPA Label System .............................................................................................................6-13

Safety Tips for Working with Hazardous Substances ............................... 6-13Chemical Spill Cleanup Procedures .....................................................................................6-14Chemical Exposure to Skin ..................................................................................................6-14

Medical Consultation & Injury Evaluation .................................................. 6-14Hazardous Chemical Waste Packaging & Disposal ................................... 6-15Special Precuations for Dental Labs ........................................................... 6-16

Silicosis ................................................................................................................................6-16Tasks in a Dental Lab that Can Cause Silica Exposure ...............................................6-16Controlling Exposure to Silica ......................................................................................6-16Other Potential Health Hazards Associated with Working in a Dental Lab ..................6-17

Allergic Reactions to Dental Products ..................................................................................6-17

Gas Cylinder Safety ...................................................................................... 6-18Electrosurgical Safety (Lasers) .................................................................. 6-19

Safe Laser Practices ............................................................................................................6-20

Radiation Safety Policies ............................................................................. 6-20Radiation Safety in Dental Practice ......................................................................................6-21Protecting Staff from Unnecessary Radiation Exposure ......................................................6-21Ionizing Radiation Exposure Limits ......................................................................................6-22Limiting Exposure to Women of Childbearing Age ...............................................................6-22Employee Training ................................................................................................................6-22Miscellaneous Ways to Minimize Radiation Exposure .........................................................6-23Regulation of the Medical Use of Nuclear By-Products .......................................................6-23Nuclear Regulatory Commission ..........................................................................................6-23

TAB 7: Infection Control A Quick Look At TB ....................................................................................... 7-1

TB Transmission ...................................................................................................................7-1Risk Factors for Developing Active TB .................................................................................7-2

TB Exposure Control Plan Policy ................................................................ 7-2Overview: How to Protect Staff from Contracting TB at Work ..............................................7-3TB Risk Assessment ............................................................................................................7-3

TB Risk Assessment Results Form (Form 21) .............................................................7-5Early Identification of Patients with Active TB ......................................................................7-6

Symptoms of TB ...........................................................................................................7-6

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Contents

Managing Patients with Suspected or Confirmed TB ...........................................................7-9TB Isolation Procedures for Cough Inducing & Aerosol-Generating Procedures.........7-9Respiratory Protection for Dental Workers: N-95 Respirators .....................................7-9

Seal Checking N-95 Respirators ..........................................................................7-10Employee TB Skin Testing (TST) .........................................................................................7-10

Baseline Employee TST: The Two-Step PPD Skin Test ...............................................7-11Two-Step TST Interpretation ................................................................................7-11

False Positive/False Negative TB Tests .......................................................................7-11Workers Who Have Had BCG Vaccination ..........................................................7-12Periodic Retesting of Employees .........................................................................7-12Recording TST Results ........................................................................................7-12

TST Record (Form 22) .................................................................................................7-13TB Skin Test Declination (Form 23) .............................................................................7-14

Evaluation & Management of Healthcare Employees Exposed to TB .................................7-15Employees with Symptoms of TB ................................................................................7-15Employees Who Have Been Exposed to a Known TB Patient ....................................7-15Positive Employee Skin Tests & Skin Test Conversions ..............................................7-15TB Exposure Log (Form 24) .........................................................................................7-16

Decontaminating Patient Care Area and Equipment ............................................................7-17Employee Training ................................................................................................................7-17

Pandemic Influenza Plan .............................................................................. 7-18Pre-pandemic Influenza Planning ........................................................................................7-18Once A Pandemic Is Announced ..........................................................................................7-21OSHA Enforcement Procedures for 2009 H1N1 ..................................................................7-23

Identifying Very High and High Exposure Risks ...........................................................7-23Dealing with N-95 Respirator Shortages ......................................................................7-24Prioritize Your Facility’s Use of N-95 Respirators .........................................................7-24Documentation .............................................................................................................7-25

Pandemic Influenza Resources............................................................................................7-26

MRSA Prevention and Control ..................................................................... 7-26MRSA Transmission .............................................................................................................7-27Patient Precautions ..............................................................................................................7-27

Hand Hygiene ..............................................................................................................7-28Contact Precautions .....................................................................................................7-28

Environmental Cleaning .......................................................................................................7-29Infected Employees ..............................................................................................................7-30MRSA Resources .................................................................................................................7-31Healthcare Worker Vaccination Recommendations 2009 ....................................................7-32

MMWR: Guidelines for Infection Control in Dental Healthcare Settings... 1-66

TAB 8: Master Record FormsGeneral Equipment and Facility Records

Safety Report .......................................................................................................................Form 1Autoclave Log .......................................................................................................................Form 2Annual OSHA Safety Program Review ................................................................................Form 3Monthly Facility Review Checklist ........................................................................................Form 4Annual Facility Review Checklist ..........................................................................................Form 5Housekeeping Schedule ......................................................................................................Form 6

xviii

Contents

Bloodborne Pathogens RecordsBloodborne Pathogens Exposure Determination List #1......................................................Form 7Bloodborne Pathogens Exposure Determination List #2......................................................Form 8Bloodborne Pathogens PPE Compliance Checklist .............................................................Form 8-ASafety Needle/Syringe Evaluation Form ..............................................................................Form 9Sharps Disposal Container Locations ..................................................................................Form 9-ABloodborne Pathogens Compliance Checklist: ECP, Training, and Records..................... ..Form 9-BSharps Evaluation Results Form ..........................................................................................Form 10

Bloodborne Pathogens Employee Medical RecordsAccident Report/Sharps Injury ..............................................................................................Form 11Sharps Injury Log .................................................................................................................Form 11-AHBV Vaccination Declination Form ......................................................................................Form 12HBV Employee Vaccination Form ........................................................................................Form 13Post Exposure Checklist ......................................................................................................Form 14Post Exposure Medical Evaluation Declination Form...........................................................Form 15Source Patient Testing Consent Form ..................................................................................Form 16

Hazard Communication Records Hazardous Substances List ..................................................................................................Form 17MSDS Request Letter ..........................................................................................................Form 18

Training RecordsNew Employee OSHA Orientation Checklist ........................................................................Form 19Annual Employee Training Record .......................................................................................Form 20Respiratory Protection Training Record ...............................................................................Form 20-A

TB / Infection Control RecordsTB Risk Assessment Results Form ......................................................................................Form 21TST Record ..........................................................................................................................Form 22TB Skin Test Declination Form .............................................................................................Form 23 TB Exposure Log ..................................................................................................................Form 24Influenza Vaccine Log ..........................................................................................................Form 25Influenza Vaccine Declination Form ....................................................................................Form 25-ADeclination of H1N1 Influenza Vaccination ..........................................................................Form 25-B

TAB 9: OSHA Regulations & Key ContactsOSHA Regulations

Bloodborne Pathogens Standard .........................................................................................9-1Amended Bloodborne Pathogens Standard (Sharps Safety) ...............................................9-13Hazard Communication Standard ........................................................................................9-14Exit Routes, Emergency Action Plans, and Fire Prevention Plans.......................................9-29Ionizing Radiation .................................................................................................................9-34Other OSHA Standards for Dental Facilities ........................................................................9-42

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Contents

Additional OSHA ResourcesSuggested Work Restriction for Employees ........................................................................9-43

Key ContactsOSHA Consultative Services State Directory .......................................................................9-47Directory of States with Approved OSHA Plans ...................................................................9-50

2-7

OSHA Program Manual for Dental Facilities

Workplace Hazard Analysis Hazards in each workplace must be identified so that they can be mitigated before accidents occur. A workplace hazard analysis identifies where interventions are needed, e.g., eye protection, lifting programs, etc.

Management has assessed risks associated with the general facility as well as all tasks performed at this site and determined that the standards below apply. Individual safety and health programs for each of these standards are located behind the designated Tabs in this Manual. These standards are:

General Facility Safety (Tab 3): Fire, Electrical, Emergency Evacuation Program, Workplace Violence.

Ergonomics (Tab 4): No longer an OSHA standard, but recommended.Bloodborne Pathogens (Tab 5): This section specifies:

- Employees who could be exposed to bloodborne pathogens- Tasks performed that could expose an employee to bloodborne pathogens, and

which PPE is required when performing these tasks- Areas in the facility where access is restricted- Areas where PPE and handwashing facilities are located

Hazard Communication and Radiation Safety (Tab 6): Describes how to handle and store hazardous substances, which are listed on the Hazardous Substances List (Form 17). Includes:

- Glutaraldehyde/peroxide-based high-level disinfectants- Gas cylinders- Lasers - Beryllium alloys- Nitrous oxide- Silica- Mercury - X-rays

Infection Control (Tab 7): contains a facility TB risk assessment, steps to take to identify potential TB patients, and procedures for avoiding TB transmission (no longer an OSHA standard, but recommended). Also includes a Pandemic Influenza Plan.

Other Hazards in This Facility:__________________________________________________________________________________________________________________________________________________________________________________________________________________

Employees who perform tasks that put them at risk for exposure to bloodborne pathogens or hazardous chemicals have been trained to understand and follow the policies and procedures in this OSHA Safety Program Manual.

Workplace hazards are reviewed and assessed through the following mechanisms: Monthly Facility Review Checklist (if performed) (Form 4). Annual Facility Review Checklist (Form 5).

2-8

OSHA Program Manual for Dental Facilities

Accident Report/Sharps Injury Log (Form 11).Safety Report for employee concerns (Form 1).Casual observation of near-misses and at-risk behaviors.

Workplace hazards are reviewed:

Whenever new substances, processes or procedures are introduced.When previously unidentified hazards are recognized.When accidents occur or workplace conditions warrant a review.

Once a potential hazard is identified, the OSHA Safety Officer records the changes to the procedures contained in the appropriate Tab of this Manual.

Employee TrainingThe OSHA Safety Officer is responsible for overseeing the employee training program, which involves yearly retraining as well as new employee orientation. It is also suggested, but not required, to conduct a brief, interactive session devoted to a safety issue at every staff meeting.

A dentist or other qualified medical professional (dental assistant, hygenist, etc.) may provide the training, as long as he/she is competent in addressing questions pertaining to OSHA compliance.

Training sessions are provided during work hours at no cost to the employee. Material appropriate in content and vocabulary to the educational level, literacy and language background of employees is used, such as videos or lectures.

Educational formats, such as live presentations, interactive or noninteractive computer programs, or videos, may be used to fulfill employee training requirements. However, a qualified person must be available to answer questions during a discussion period specifically for all types of bloodborne pathogens training. A telephone hotline may suffice in fulfilling this requirement, according to January 17, 2008, OSHA interpretation letters; however, voice mail, e-mail, paging systems, or other methods that don’t guarantee an immediate response are not compliant. For more details on the interactive requirement, search for “Clarification on trainer requirements and access to trainer under OSHA’s bloodborne pathogens standard” at www.osha.gov or call the HCPro OSHA consultation line at (800) 650-6787.

The training must contain information that none of these formats can accomplish, such as:Where the OSHA manual and MSDS binder are located in the facility.Where fire extinguishers, eyewash stations and exit doors are located in the facility.Where personal protective equipment is located in the facility.

Checklist for an Effective Safety Training Session

Safety presentations, as we all know, are not often very entertaining. Employees rarely expect to be amused or involved.

TAB 8: MASTER RECORD FORMS

Contents

General Equipment and Facility RecordsForm 1 Safety Report…………………..…................ Use to document employee complaints; staff

meeting minutes.

Form 2 Autoclave Log…………………..………........ Use weekly, or as indicated to record performance of biological indicator tests.

Form 3 Annual OSHA Safety Program Review….... Use annually to document that this manual was reviewed and updated.

Form 4 Monthly Facility Review Checklist................Use monthly (optional form).

Form 5 Annual Facility Review Checklist…….......... Use annually.

Form 6 Housekeeping Schedule………..…….......... Use initially.

Bloodborne Pathogens RecordsForm 7 Bloodborne Pathogens Exposure

Determination List #1………………….........Use initially, and whenever new clinical staff is added.

Form 8 Bloodborne Pathogens Exposure Determination List #2………………..….......

Use initially, and whenever new clinical staff is added.

Form 8-A Bloodborne Pathogens PPE Compliance Checklist…………..…...….......

Use periodically to monitor compliance with the PPE sections of the bloodborne pathogens standard.

Form 9 Safety Needle/Syringe Evaluation Form…. Use initially, and whenever new safety devices are under consideration.

Form 9-A Sharps Disposal Container Locations......... Use periodically to monitor compliance for sharps disposal container locations.

Form 9-B Bloodborne Pathogens Compliance Checklist: ECP, Training, and Records........

Use periodically to monitor compliance for sharps disposal container locations.

Form 10 Sharps Evaluation Results Form…….......... Use initially, and whenever new safety devices are under consideration.

Bloodborne Pathogens Employee Medical RecordsForm 11 Accident Report/Sharps Injury Log.............. Use when an employee injury occurs, including sharps

injuries and other bloodborne pathogens exposures.

Form 11-A Sharps Injury Log.........................................Use to compile sharps injury device data for sharps evaluation.

Form 12 HBV Vaccination Declination Form……....... Use when an employee is given the hepatitis B vaccine or declines this vaccine.

Contents

Form 13 HBV Employee Vaccination Form…….........Use when an employee is given the hepatitis B vaccine or declines this vaccine.

Form 14 Post Exposure Checklist…………….…........Use to document that all required actions were taken after a sharps injury or employee exposure to bloodborne pathogens.

Form 15 Post Exposure Medical Evaluation Declination Form………………….................

Use to document a particular employee refusing post exposure testing and treatment.

Form 16 Source Patient Testing Consent Form…………………..…..…..........

Use to obtain consent from a source patient after an exposure incident such as a needlestick.

Hazard Communication Records Form 17 Hazardous Substances List…….……......... Use initially to list all hazardous chemicals in your

facility and when a new hazardous chemical is introduced.

Form 18 MSDS Request Letter…………..…….......... Use when a new hazardous chemical is intro duced to document attempts to procure a MSDS.

Training RecordsForm 19 New Employee OSHA

Orientation Checklist……………………......Use to document initial OSHA training when new staff members are added.

Form 20 Annual Employee Training Record….......... Use annually.

Form 20-A Respiratory Protection Training Record……Use annually.

TB / Infection Control Records Form 21 TB Risk Assessment Results Form…......... Use annually.

Form 22 TST Record……………..………………....... Use as indicated, based on your facility’s risk assessment.

Form 23 TB Skin Test Declination Form………......... Use when an employee declines receiving a TB skin test.

Form 24 TB Exposure Log……………….…...…........ As indicated when employees are exposed to a known TB patient.

Form 25 Influenza Vaccine Log………....………........ Use annually to vaccinate all employees.

Form 25-A Influenza Vaccine Declination Form….......... Use when an employee declines this vaccine.

Form 25-B Declination of H1N1 Influenza Vaccination.. Use when an employee declines this vaccine.

OSHA Program Manual for Dental Facilities

Form 9-B

BloodBorne pathogens compliance checklist:

ecp, training, and records Use this checklist to periodically monitor compliance with the exposure control plan and

training and records sections of the Bloodborne Pathogens standard, 1910.1030.

section requirements compliance

exposure control plan (ecp)(c)(1)(i) This facility has a written ECP for employers with occupational

exposure to blood or other potentially infectious material (OPIM).Yes No

(c)(1)(iii) A copy of the ECP is accessible to all employees. Yes No

(c)(1); (c)(2)(i)(C); (c)(2)(ii)

An exposure determination has been completed for work classifications or individual employees with occupational exposure to blood or OPIM.

Yes No

(c)(1)(ii)(A) The tasks of each employee are closely checked to identify any potential exposure to blood or other infectious products.

Yes No

(c)(1); (c)(2)(ii) Determining whether tasks are subject to occupational exposure is done as if personal protective equipment (PPE) is not used.

Yes No

(c)(1)(ii)(C) The exposure control plan includes the procedure for the evaluation of circumstances surrounding exposure incidents.

Yes No

(c)(1)(iv) The facility reviews and updates the ECP at least annually and whenever necessary to reflect new or modified tasks and procedures that affect occupational exposure, and to reflect new or revised employee positions with occupational exposure.

Yes No

(c)(1)(iv)(A) The exposure control plan reflects changes in technology that eliminate or reduce exposures to bloodborne pathogens and documents annual consideration and implementation of safer medical devices.

Yes No

(c)(1)(v) The input of nonmanagerial employees responsible for direct patient care who are potentially exposed to injuries from contaminated sharps in the identification, evaluation, and selection of effective engineering and work practice controls is documented in the exposure control plan.

Yes No

training and records(g)(2)(i)–(vi) Bloodborne pathogens training is provided: 1) to all exposed

employees, 2) at no cost, 3) during working hours, 4) before exposure may occur, 5) annually, 6) when new procedures are introduced, and 7) with material appropriate to the education, literacy level, and language of employees.

Yes No

Persons who are not employees but who work in this facility (e.g., janitorial and temporary service staff, contract employees, and support service personnel) have been informed of the bloodborne pathogens program and the use of PPE.

Yes No

OSHA Program Manual for Dental Facilities

Form 9-B

section requirements complianceAll exposed salaried physicians have undergone training in the facility’s bloodborne pathogens program and have been offered hepatitis B virus (HBV) immunization.

Yes No

(g)(2)(vii) The training program contains at a minimum the elements listed in sections (A)-(M).

Yes No

(g)(2)(vii)(N) Training sessions provide an opportunity for questions and discussion between the trainer and the worker.

.Yes No

(g)(2)(viii) The trainer is knowledgeable about the subject matter and relates training content to the workplace in a realistic way.

Yes No

(h)(2)(i)(A-D) Training records include the dates of the training sessions, the contents or a summary of the training session, the names and qualifications of the people conducting the training, and the names and job titles of everyone attending the training sessions.

Yes No

(h)(2)(ii) Training records are maintained for three years from the date of the session.

Yes No

(h)(3)(i)–(iii) Training records and medical records of exposed employees are available in accordance with OSHA regulations.

Yes No

(h)(4)(i)–(ii) A policy is in effect governing the transfer of training and medical records if the business closes.

Yes No

(h)(1)(i) This facility maintains medical records for each employee who has had occupational exposure.

Yes No

(h)(1)(ii)(A–E) Medical records include Social Security numbers and HBV vaccination status, including the dates of all HBV vaccinations and medical records relative to the employee’s ability to receive vaccination.

Yes No

Medical records include a copy of the healthcare professional’s written opinions pertaining to employee exams, medical testing, and follow-up procedures. A copy of the information provided to the healthcare professional by the employer should also be included.

Yes No

(h)(1)(iii) The organization keeps the records and does not disclose them without the employee’s written permission.

Yes No

(h)(1)(iv) The organization maintains medical records for at least the duration of employment plus 30 years.

Yes No

(Bloodborne pathogens compliance checklist, page 2 of 2)