osha manual for dental offices

v2020.A

Prepared in consultation with authorized OSHA trainers and experts, dental and healthcare professionals

Note: This manual provides extensive coverage of various safety regulations for dental facilities mandated by OSHA. The information has been mainly collected from Occupational Safety and Health Administration (OSHA) regulatory texts. Additional information has been collected from materials published by the National Institute of Safety and Health (NIOSH) and the Center for Disease Control (CDC). It is our intention to make OSHA compliance easy for your facility. The manual has comprehensive information for training purposes only. If you need documentation for all the various plans mandated by OSHA, you must purchase our documentation kit, which is sold separately. Please refer to the training outline that has been provided to assist you in navigating through this manual.

© Copyright Gamma Compliance Solutions LLC. All rights reserved.

OSHA Manual for Dental Offices

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GAMMA COMPLIANCE SOLUTIONS

Table of Contents

1 Introduction to OSHA ................................................................................................... 1

What OSHA Does ................................................................................................... 2

OSHA’s Impact ........................................................................................................ 3

OSHA’s Continuing Role ........................................................................................ 3

OSHA Coverage ....................................................................................................... 4

1.4.1 Who is Not Covered? ....................................................................................... 4

1.4.2 Federal and State Government Employees Coverage .................................. 4

1.4.3 State Programs ................................................................................................... 4

1.4.4 State Program Coverage ................................................................................... 5

Standards and Guidance .......................................................................................... 5

Hazards Addressed ................................................................................................... 5

General Duty Clause ................................................................................................ 6

Mandatory Posting Requirements .......................................................................... 6

Reporting ................................................................................................................... 7

1.9.1 OSHA’s Reporting Requirements ................................................................... 7

OSHA Enforcement Activities ........................................................................... 7

1.10.1 Enhanced Enforcement Program (EEP).................................................... 8

1.10.2 The OSHA Whistleblower Program ........................................................... 8

1.10.3 How to File an OSHA Complaint ............................................................... 9

1.10.4 Discrimination Complaints ........................................................................... 9

OSHA’s Cooperative Programs ........................................................................ 10

1.11.1 Agreement renewing an alliance between OSHA and ADA.................. 10

Effective Workplace Safety and Health Management Systems .................... 12

Safety and Health Management Systems Checklist ........................................ 12

1.13.1 Management Commitment and Employee Involvement ....................... 12

1.13.2 Worksite Analysis ......................................................................................... 12

1.13.3 Hazard Prevention and Control ................................................................. 13

1.13.4 Training for Employees, Supervisors, and Managers .............................. 13

Employee Rights under OSH Act .................................................................... 13

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Employer Responsibilities ................................................................................. 14

1.15.1 Employee Rights When an Employer Files a Variance .......................... 14

1.15.2 Worker Rights to Access Records and Test Results ............................... 15

1.15.2.1 Access to Exposure and Medical Records ............................................ 15

1.15.2.2 Right to Review Injury and Illness Records .......................................... 15

1.15.2.3 Employee Rights to Promote Workplace Safety .................................. 15

1.15.2.4 Right to Refuse to Perform Unsafe Work ............................................ 16

1.15.3 Recourse If the Employer Does Not Correct a Hazard ......................... 16

1.15.4 Worker Rights During the Inspection Process ........................................ 16

1.15.4.1 Right to Representation ........................................................................... 16

1.15.4.2 Right to Help the Compliance Officer .................................................. 17

1.15.4.3 Rights to Information Following the Inspection ................................. 17

1.15.5 How to Challenge the Abatement Period ................................................. 17

1.15.6 Right to Information If No Inspection Is Conducted or No Citation Issued 17

1.15.7 Worker Rights to Protection from Retaliation ......................................... 18

1.15.7.1 Right to Confidentiality ........................................................................... 18

1.15.7.2 Whistleblower Protections ...................................................................... 18

OSHA Inspections.............................................................................................. 19

1.16.1 Inspection Priorities .................................................................................... 19

1.16.1.1 Imminent Danger Situations ................................................................... 19

1.16.1.2 Catastrophic and Fatal Accidents (Serious Accidents) ........................ 19

1.16.1.3 Employee Complaints.............................................................................. 19

1.16.1.4 Agency Referrals ....................................................................................... 19

1.16.1.5 Follow-ups ................................................................................................. 20

1.16.1.6 Planned or Programmed Investigations ................................................ 20

1.16.2 Phone/Fax Investigations .......................................................................... 20

1.16.3 Onsite Inspections ....................................................................................... 20

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1.16.3.1 Preparation ................................................................................................ 20

1.16.3.2 Presentation of Credentials ..................................................................... 20

1.16.3.3 Opening Conference ................................................................................ 20

1.16.3.4 Walk Around ............................................................................................. 21

1.16.3.5 Closing Conference .................................................................................. 21

1.16.4 Results of Inspection ................................................................................... 21

1.16.5 Appeals .......................................................................................................... 22

1.16.6 OSHA Penalties ........................................................................................... 22

1.16.6.1 Willful......................................................................................................... 22

1.16.6.2 Serious ........................................................................................................ 22

1.16.6.3 Other Than Serious .................................................................................. 22

1.16.6.4 De Minimis ................................................................................................ 23

1.16.6.5 Failure to Abate ........................................................................................ 23

1.16.6.6 Repeated .................................................................................................... 23

1.16.7 Follow-up Inspection and Failure to Abate ............................................. 24

Safety and Health Program at Your Workplace .............................................. 24

1.17.1 Worksite Analysis ......................................................................................... 25

Injury and Illness Prevention Programs (IIPP) ............................................... 26

1.18.1 Key Features of the Injury and Illness Prevention Program .................. 27

Bibliography ......................................................................................................... 28

2 Recordkeeping Requirements (29 CFR Part 1904)................................................... 29

Importance of Recordkeeping .............................................................................. 29

Log of Work-Related Injuries and Illnesses (OSHA Form 300) ...................... 29

2.2.1 How to Work with the Log (OSHA Form 300) ......................................... 30

2.2.2 Exceptions for Not Entering Employee’s Name on the OSHA Form 30030

Summary of Work-Related Injuries and Illnesses (OSHA Form 300A) ......... 31

Injury and Illness Incident Report (OSHA Form 301) ..................................... 32

2.4.1 Procedure for Recording Injuries .................................................................. 32

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Employee Involvement ......................................................................................... 32

Work-Related Injuries or Illnesses ....................................................................... 33

2.6.1 Exceptions According to 29 CFR 1904.5(b)(2) ........................................... 33

2.6.2 Recordable Work-Related Injuries and Illnesses ......................................... 34

2.6.3 Additional Criteria for Recording Injuries ................................................... 34

Definition of Medical Treatment ......................................................................... 35

2.7.1 First Aid ............................................................................................................ 35

Restricted Work ...................................................................................................... 36

2.8.1 How to Calculate the Number of Restricted Work Activity Days or Days Away from Work .......................................................................................................... 36

Classifying Injuries ................................................................................................. 36

Classifying Illnesses ............................................................................................ 37

2.10.1 Skin Diseases or Disorders ......................................................................... 37

2.10.2 Respiratory Conditions ............................................................................... 37

2.10.3 Poisoning ...................................................................................................... 37

2.10.4 Hearing Loss ................................................................................................. 37

2.10.5 All Other Illnesses ....................................................................................... 38

Bibliography ......................................................................................................... 38

3 Bloodborne Pathogen Standard (29 CFR Part 1910.1030) ..................................... 39

Basic requirements of the OSHA bloodborne pathogens standard ................ 40

Epidemiology .......................................................................................................... 41

3.2.1 Introduction ..................................................................................................... 41

3.2.2 Steps to Be Taken by the Employee After Exposure ................................. 41

3.2.3 Prevention of Occupational Exposures ....................................................... 42

3.2.4 Risk of Infection after exposure .................................................................... 43

3.2.4.1 HBV ........................................................................................................... 43

3.2.4.2 HCV ........................................................................................................... 44

3.2.4.3 HDV .......................................................................................................... 44

3.2.4.4 HIV ............................................................................................................ 45

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3.2.5 Treatment for the Exposure .......................................................................... 46

3.2.5.1 HBV ........................................................................................................... 46

3.2.5.2 HCV ........................................................................................................... 46

3.2.5.3 HIV ............................................................................................................ 47

3.2.6 Recommended Drugs for Post-Exposure Treatment ................................ 47

3.2.6.1 HBV ........................................................................................................... 47

3.2.6.2 HCV ........................................................................................................... 47

3.2.6.3 HIV ............................................................................................................ 47

3.2.7 Side Effects ...................................................................................................... 48

3.2.7.1 HBV ........................................................................................................... 48

3.2.7.2 HIV ............................................................................................................ 49

3.2.8 G. Post-exposure Follow-Up ......................................................................... 49

3.2.8.1 HBV ........................................................................................................... 49

3.2.8.2 HCV ........................................................................................................... 50

3.2.8.3 HIV ............................................................................................................ 50

Basic Requirements of the OSHA Bloodborne Pathogens Standard .............. 51

3.3.1 Preparing an Exposure Control Plan [29 CFR 1910.1030(c)(1)] ............... 51

3.3.2 Annual Review and Update............................................................................ 51

3.3.3 Exposure Determination [29 CFR 1910.1030(b)] ....................................... 51

3.3.4 Job Classifications ........................................................................................... 52

Methods of Compliance [29 CFR 1910.1030(c)(1)(ii)(B)] ................................. 53

3.4.1 Standard Precautions ...................................................................................... 53

3.4.2 Sharps Injury Prevention Program under the Needlestick and Prevention Act, 2001 ........................................................................................................................ 54

3.4.2.1 Management Commitment ..................................................................... 54

3.4.2.2 Identifying Safer Dental Devices............................................................ 54

3.4.2.3 Developing Evaluation Criteria .............................................................. 54

3.4.2.4 Screening Devices .................................................................................... 55

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3.4.2.5 Evaluating Devices ................................................................................... 55

3.4.2.6 Procedures for Sharps Injury Reporting ............................................... 56

3.4.2.7 Analyze Injury Data ................................................................................. 56

3.4.2.8 Educate and Train Facility Personnel .................................................... 57

3.4.2.9 Sharps with Engineered Sharps Injury Protections (SESIPs) ............. 57

3.4.3 Engineering and Work Practice Controls [29 CFR 1910.1030 (d)(2)] ...... 58

3.4.3.1 Hand Hygiene ........................................................................................... 61

3.4.3.2 Procedures for Maintaining Adequate Hand Hygiene ......................... 62

3.4.3.3 Special Considerations for Hand Hygiene and Glove Use ................. 62

3.4.4 Personal Protective Equipment (PPE) [29 CFR 1910.1030(d)(3)] ............ 63

3.4.4.1 Gloves Requirements ............................................................................... 64

3.4.4.2 Masks, Eye Protection, and Face Shields .............................................. 65

3.4.4.3 Gowns, Aprons, and Other Protective Body Clothing ....................... 65

3.4.4.4 Training Employees in the Proper Use of PPE ................................... 65

3.4.5 Housekeeping .................................................................................................. 65

3.4.5.1 Use of Disinfectants ................................................................................. 67

3.4.5.2 Disinfecting Contaminated Instruments and Equipment ................... 68

3.4.5.3 Protective Coverings ................................................................................ 68

3.4.5.4 Reusable Containers ................................................................................. 68

3.4.5.5 Glassware .................................................................................................. 68

3.4.5.6 Laundry ...................................................................................................... 69

3.4.5.7 Handling Biopsy Specimens .................................................................... 69

3.4.5.8 Regulated Waste [29 CFR 1910.1030(d)(4)(iii)] .................................... 70

3.4.5.9 Medical Waste Transporter ..................................................................... 71

Provision of Hepatitis B Vaccine to Exposed Employees at No Cost ........... 71

Medical Follow-up in the Event of an Exposure Incident ............................... 72

3.6.1 Incident Reporting .......................................................................................... 72

3.6.2 Referral to a Licensed Healthcare Professional [29 CFR 1910.1030 (f)(4)] 72

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3.6.3 Documentation [29 CFR 1910.1030(f)(3)(i)] ............................................... 73

3.6.4 Information Provided to HCP [29 CFR 1910.1030(f)(4)(ii)] ..................... 73

3.6.5 Identification and Testing of Source Patient’s Blood [29 CFR 1910. 1030(f)(3)(iii)(A)] ........................................................................................................... 73

3.6.6 Collection and Testing of Employee’s Blood [29 CFR 1910.1030(f)(3) (iii)(B)] 74

3.6.6.1 Counseling [29 CFR 1910.1030(f)(3)(v)] ............................................... 74

3.6.6.2 Post-Exposure Prophylaxis [29 CFR 1910.1030(f)(3)(iv)] .................. 75

3.6.6.3 Evaluation of Reported Illnesses [29 CFR 1910.1030(f)(3)(vi)] ......... 75

3.6.7 ................................................................................................................................ 75

3.6.8 Healthcare Professional’s Written Opinion [29 CFR 1910.1030(f)(5)] .... 75

3.6.9 Medical Recordkeeping [29 CFR 1910.1030(h)(1)] ..................................... 75

3.6.10 Medical Follow-up in the Event of an Exposure Incident ..................... 77

Use of Labels/ Labeling Requirements [29 CFR 1910.1030(g)(1)(i)] .............. 78

3.7.1 General Requirements .................................................................................... 78

3.7.2 Labeling Exception for Blood Products....................................................... 78

Bloodborne Pathogen Training ............................................................................ 78

Recordkeeping ........................................................................................................ 79

3.9.1 Training Records [29 CFR 1910.1030(h)(2)] ................................................ 79

3.9.2 Medical Records [29 CFR 1910.1030(h)(1)] ................................................. 80

3.9.3 Identification, Evaluation, and Selection of Effective Engineering and Work Practice Controls ................................................................................................ 80

3.9.4 Sharps Injury Log [29 CFR 1910.1030(h)(5)] .............................................. 81

3.9.5 Hepatitis B Vaccine Declination (Mandatory) [29 CFR 1910.1030(f) (2)(iv)]. 81

Proper Containment of Medical Wastes .......................................................... 81

3.10.1 Disposal of Extracted Teeth ...................................................................... 82

3.10.2 Storage of Medical Wastes at the Facility ................................................. 85

3.10.3 Disposal of Regulated Medical Wastes ..................................................... 87

Bibliography ......................................................................................................... 88

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4 General Infection Control in Dentistry ..................................................................... 89

Importance of Infection Control in Dentistry .................................................... 89

Modes of Transmission of Infectious Materials at a Dental Office ................ 89

Chain of Infection Model ...................................................................................... 89

General Duty Clause .............................................................................................. 90

4.4.1 Aerosol and Splatter in Dentistry and Its Implications .............................. 91

4.4.1.1 Dangers of Aerosol .................................................................................. 91

4.4.1.2 Methods to Eliminate Bacterial Aerosols .............................................. 91

Sterilization and Disinfection of Patient Care Items ......................................... 92

4.5.1 General Recommendations for Sterilization Procedures ........................... 93

4.5.2 Instrument Processing Area ........................................................................... 93

4.5.2.1 Designate a Central Processing Area. .................................................... 93

4.5.2.2 Preparation and Packaging ...................................................................... 94

4.5.2.3 Sterilization ................................................................................................ 94

4.5.2.4 Storage Area for Sterilized Items and Clean Dental Supplies ............. 96

Dental Unit Waterlines, Biofilm, and Water Quality ......................................... 96

4.6.1 Cleaning Dental Waste Lines ......................................................................... 97

4.6.1.1 Municipal water supply. ........................................................................... 97

4.6.1.2 Self-contained water system. ................................................................... 98

4.6.1.3 Basic cleaning procedures ....................................................................... 98

4.6.2 Options for Improving Dental Water Quality ............................................. 98

4.6.2.1 Filters ......................................................................................................... 98

4.6.2.2 Chemicals .................................................................................................. 98

4.6.2.3 Water Purifiers .......................................................................................... 99

4.6.3 Monitoring of Water Quality ......................................................................... 99

Aseptic Technique for Parenteral Medications................................................... 99

Oral Surgical Procedures ..................................................................................... 100

Dental Radiology .................................................................................................. 100

Bibliography ....................................................................................................... 102

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5 Hazard Communication Standard (29 CFR 1910.1200) ........................................ 103

Introduction .......................................................................................................... 103

The Right to Know .............................................................................................. 103

Requirements and Responsibilities ..................................................................... 104

5.3.1 Applicability ................................................................................................... 104

5.3.1.1 Applicable Chemicals ............................................................................. 104

5.3.2 Written Hazard Communication Program ................................................. 105

5.3.3 Chemical Inventory and Safety Data Sheets .............................................. 105

5.3.4 Labels [29 CFR 1910.1200(f)] ...................................................................... 106

5.3.5 Training ........................................................................................................... 107

5.3.6 Responsibilities .............................................................................................. 108

5.3.6.1 Supervisor Responsibilities.................................................................... 109

5.3.6.2 Employee Responsibilities .................................................................... 109

5.3.7 Recordkeeping ............................................................................................... 109

Required Employee Information and Training ................................................ 110

5.4.1 Training [29 CFR 1910.1200(h)] .................................................................. 110

5.4.1.1 Required Training and Frequency of Training ................................... 110

5.4.1.2 Purpose and Content of Training ........................................................ 111

5.4.1.3 Requirements of Retraining a New Hire ............................................. 111

5.4.2 Reading and Interpreting SDSs [29 CFR 1910.1200(g)] ........................... 112

5.4.2.1 OSHA Requirements for SDS .............................................................. 112

5.4.2.2 Exemptions to SDS ............................................................................... 113

5.4.2.3 SDSs for Ointments, Creams, and Other Topical Preparations that

Do Not Contain Hazardous Chemicals ................................................................ 113

5.4.2.4 Storing SDS information in the Computer [29 CFR 1910.1200(g)(8)]

113

5.4.2.5 Safety Data Sheet (SDS) Contents ....................................................... 114

5.4.2.6 Hazard Classification ............................................................................. 115

5.4.2.7 Trade Secrets [29 CFR 1910.1200(i)] ................................................... 115

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5.4.2.8 Labels and Signs [29 CFR 1910.1200(f)(5)]......................................... 116

5.4.3 Limiting Chemical Exposures ...................................................................... 116

5.4.3.1 Engineering Controls ............................................................................. 117

5.4.3.2 Safe Work Practices ............................................................................... 117

5.4.3.3 Personal Protective Equipment (PPE) ................................................ 117

5.4.4 Chemical Procurement, Distribution, Storage, and Disposal .................. 117

5.4.4.1 Procurement ............................................................................................ 117

5.4.4.2 Distribution ............................................................................................. 118

5.4.4.3 Storage ..................................................................................................... 118

5.4.4.4 Disposal ................................................................................................... 118

Chemical Hazards and Emergency Response ................................................... 118

5.5.1 Exposure Levels ............................................................................................ 118

5.5.2 Spill Control Policy ....................................................................................... 119

5.5.2.1 Spill Emergency Plan ............................................................................. 119

5.5.3 Common Chemicals ...................................................................................... 120

5.5.3.1 Formocresol ............................................................................................ 121

5.5.3.2 Antineoplastic (Chemotherapeutic) Agents ........................................ 121

5.5.3.3 Disinfecting Agents ................................................................................ 121

5.5.3.4 Housekeeping Chemicals ...................................................................... 122

5.5.3.5 Anesthetic Gases .................................................................................... 122

5.5.3.6 Compressed Gases ................................................................................. 123

5.5.3.7 Mercury .................................................................................................... 123

5.5.3.8 Isopropyl Alcohol................................................................................... 124

5.5.3.9 Formaldehyde and Formalin Solutions ............................................... 124

5.5.3.10 Prescription Drugs ................................................................................. 124

5.5.3.11 Pentamidine............................................................................................. 125

5.5.3.12 Ribavirin (Virazole) ................................................................................ 125

5.5.3.13 Dental Devices........................................................................................ 125

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5.5.4 Definitions of Hazards (29 CFR 1910.1200(c)) ......................................... 128

5.5.5 Chemical Inventory [29 CFR 1910.1200(e)(1)(i)] ...................................... 128

5.5.6 Sample GHS Safety Data Sheet ................................................................... 130

5.5.7 Training Requirements for GHS Labels and SDS .................................... 139

5.5.8 Transition to Globally Harmonized System (GHS).................................. 139

5.5.9 Reasons for Revision of Hazard Communication Standard .................... 141

Bibliography .......................................................................................................... 142

6 Exposure to Beryllium in Dental Laboratories ....................................................... 143

Identification of Dental Alloys That Contain Beryllium ................................. 143

Chronic Beryllium Disease .................................................................................. 143

6.2.1 Beryllium Sensitization ................................................................................. 143

6.2.2 Signs and Symptoms of Chronic Beryllium Disease ................................. 144

Measures to Reduce Beryllium Exposure .......................................................... 144

6.3.1 Engineering Controls .................................................................................... 144

6.3.2 Work Practices to Reduce Beryllium Exposure ........................................ 145

6.3.3 Hygiene, Clothing, Housekeeping Procedures, and Personal Protective Equipment ................................................................................................................... 145

6.3.4 Respiratory Protection .................................................................................. 146

6.3.5 Training and Information ............................................................................. 146

Health Surveillance Methods for Beryllium Sensitization and Chronic Beryllium Disease: ............................................................................................................................ 147

6.4.1 For Employers ............................................................................................... 147

6.4.2 For Employees ............................................................................................... 148

6.4.3 Blood Testing for Beryllium Sensitization ................................................. 148

6.4.3.1 Testing Laboratory ................................................................................. 149

6.4.3.2 Medical Research Centers ..................................................................... 149

Bibliography .......................................................................................................... 150

7 Exposure to Nitrous Oxide ....................................................................................... 151

Chronic Exposure to N2O ................................................................................. 151

7.1.1 Chronic Exposure Disorders ....................................................................... 151

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7.1.1.1 System Maintenance ............................................................................... 152

Bibliography .......................................................................................................... 152

8 Ionizing Radiation (29 CFR 1910.1096) .................................................................. 153

Potential Hazard of Radiation Exposure........................................................... 153

Possible Solutions ................................................................................................. 153

Radiation Exposure Controls ............................................................................. 154

8.3.1 Monitoring...................................................................................................... 156

8.3.1.1 Personal Dosimeters .............................................................................. 156

8.3.1.2 Direct Reading Survey Meters and Counters ...................................... 156

8.3.1.3 Continuous Monitors ............................................................................. 156

8.3.1.4 Long-term Samplers ............................................................................... 156

Radiation Area ...................................................................................................... 157

8.4.1 High-radiation Area ...................................................................................... 157

8.4.2 Rem ................................................................................................................. 157

8.4.3 Rad .................................................................................................................. 158

8.4.4 Permissible Exposure of Individuals to Ionizing Radiation in Restricted Areas 158

Precautionary Procedures and Personal Monitoring [29 CFR 1910.1096 (d)]159

8.5.1 Recordkeeping ............................................................................................... 159

8.5.2 Checklist for Exposure to Radiation ........................................................... 159

Bibliography .......................................................................................................... 160

9 LASER Safety Standard ............................................................................................. 161

Classification of Lasers ........................................................................................ 161

9.1.1 Class I .............................................................................................................. 162

9.1.2 Class II ............................................................................................................ 162

9.1.3 Class IIIa ......................................................................................................... 162

9.1.4 Class IIIb ........................................................................................................ 162

9.1.5 Class IV ........................................................................................................... 163

Ventilation ............................................................................................................. 163

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Work Practices ...................................................................................................... 164

Engineering Controls ........................................................................................... 164

9.4.1 Protective Housing ........................................................................................ 164

9.4.2 Master Switch Control .................................................................................. 165

9.4.3 Optical Viewing System Safety ................................................................... 165

9.4.4 Beam Stop or Attenuator ............................................................................. 165

9.4.5 Laser Activation Warning System ............................................................... 165

9.4.6 Service Access Panels .................................................................................... 165

9.4.7 Protective Housing Interlock Requirements.............................................. 166

9.4.8 Remote Interlock Connector ....................................................................... 166

Protective Equipment .......................................................................................... 166

9.5.1 Laser Protective Eyewear and Clothing ..................................................... 166

9.5.2 Laser Barriers and Protective Curtains ....................................................... 167

Bibliography .......................................................................................................... 167

10 Ergonomics Hazards and Prevention ................................................................... 169

Guidelines .......................................................................................................... 170

Enforcement ...................................................................................................... 170

Outreach and Assistance .................................................................................. 170

National Advisory Committee ........................................................................ 170

Identifying Conditions That Contribute to Musculoskeletal Disorders .... 171

10.5.1 Step 1: Review Injury and Illness Records .............................................. 171

10.5.2 Step 2: Identify Potential MSD Cases ..................................................... 171

10.5.3 Step 3: Categorize ...................................................................................... 172

10.5.3.1 Analysis of Job or Work Tasks ............................................................. 172

Good Safety and Health Program in Ergonomics........................................ 173

10.6.1 Management Leadership/Employee Participation: ............................... 173

10.6.2 Workplace Analysis.................................................................................... 174

10.6.3 Accident and Record Analysis .................................................................. 174

10.6.4 Hazard Prevention and Control ............................................................... 174

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10.6.5 Medical Management ................................................................................. 174

10.6.6 Training ....................................................................................................... 175

Common Ergonomic Hazards ........................................................................ 175

10.7.1 At the Admission and Records Office .................................................... 175

10.7.1.1 Possible Solutions ................................................................................... 176

10.7.2 Computer Workstation ............................................................................. 176


Ergonomic Factors among Dentists and Dental Assistants ........................ 177

10.8.1 Neck and Shoulder .................................................................................... 177

10.8.2 Wrist and Hand .......................................................................................... 177

10.8.3 Low Back Pain ........................................................................................... 177

10.8.4 Psychosocial Factors and Work-Related MSDs in Dentistry ............... 178


10.8.5 Four-handed Dentistry .............................................................................. 179

10.8.6 Task Rotation ............................................................................................. 179

10.8.7 Use of Carbonless Paper ........................................................................... 180


10.8.8 Patient Handling Controls ........................................................................ 180


10.8.9 Awkward Postures ..................................................................................... 181


10.8.10 Transferring Equipment ........................................................................... 182

10.8.11 Reaching into Deep Sinks or Containers ................................................ 182

10.8.12 Lifting Trash, Laundry, or Other Large Kinds of Bags ........................ 183

10.8.13 Handling Bags ............................................................................................ 183

10.8.14 Moving Heavy Carts .................................................................................. 183

10.8.15 Housekeeping Tasks .................................................................................. 184

Bibliography ....................................................................................................... 185

11 Latex Allergy ............................................................................................................. 187

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Possible Solutions ............................................................................................. 188

NIOSH Recommendations ............................................................................. 188

Bibliography ....................................................................................................... 189

12 Exposure to Tuberculosis ....................................................................................... 191

Dental Treatment and Tuberculosis ............................................................... 191

Causes of Tuberculosis..................................................................................... 192

Employee Safety ................................................................................................ 192

Tuberculin Skin Test (TST) ............................................................................. 193

Tuberculosis Infection Control ....................................................................... 193

12.5.1 Administrative Controls ............................................................................ 193

12.5.1.1 Accident Prevention Signs and Tags [29 CFR 1910.145] .................. 193

12.5.2 Environmental Controls ........................................................................... 194

12.5.3 Respiratory Protection (RP) Controls ..................................................... 194

Respiratory Protection Program ..................................................................... 195

12.6.1 General Recommendations ...................................................................... 195

12.6.2 Respiratory Protection Standard [29 CFR 1910.134] ............................ 196

TB Risk Classifications ..................................................................................... 196

12.7.1 Low risk....................................................................................................... 196

12.7.2 Medium risk ................................................................................................ 196

12.7.3 Potential ongoing transmission ................................................................ 197

12.7.4 TB Screening Procedures for Settings or Dental Workers Classified as Low Risk 197

12.7.5 TB Screening Procedures for Settings or Dental Workers Classified as Medium Risk................................................................................................................ 197

12.7.6 TB Screening Procedures for Settings Classified as Potential Ongoing Transmission ............................................................................................................... 198

TB Training and Education ............................................................................. 198

Access to Employee Medical and Exposure Records [29 CFR 1910.20] .. 198

Recordkeeping [29 CFR 1904] ........................................................................ 199

Bibliography ....................................................................................................... 199

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13 Pandemic Influenza Preparedness and Response Guidance for Healthcare Workers and Healthcare Employers ................................................................................ 201

Epidemiology of Influenza Virus.................................................................... 201

13.1.1 Seasonal influenza ...................................................................................... 202

13.1.2 Avian influenza .......................................................................................... 202

13.1.3 Pandemic influenza .................................................................................... 202

Respiratory Hygiene/Cough Etiquette .......................................................... 203

Infection Control .............................................................................................. 204

13.3.1 Standard Precautions ................................................................................. 204

13.3.2 Contact Precautions ................................................................................... 205

13.3.2.1 Droplet Precautions ............................................................................... 205

13.3.2.2 Airborne precautions ............................................................................. 206

Staff Education and Training .......................................................................... 207

California’s ATD Regulations ......................................................................... 208

Bibliography ....................................................................................................... 209

14 Workplace Violence ................................................................................................ 211

What is Workplace Violence? .......................................................................... 211

Examples of Workplace Violence ................................................................... 212

Who Is at Risk? ................................................................................................. 212

Types of Workplace Violence ......................................................................... 212

Statistics on Workplace Violence .................................................................... 212

What Are the Effects of Violence? ................................................................. 212

What are the Risk Factors for Workplace Violence?.................................... 213

Prevention Strategies for Employers .............................................................. 213

14.8.1 Environmental Designs ............................................................................ 213

14.8.2 Administrative Controls ............................................................................ 214

14.8.3 Behavior Modifications ............................................................................. 214

Dealing with the Consequences of Violence ................................................. 214

Safety Tips for Dental Facility Workers ......................................................... 215

14.10.1 Maintain Behavior that Helps Diffuse Anger ........................................ 215

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14.10.2 Be Alert ....................................................................................................... 215

14.10.3 Take These Steps If You Can’t Diffuse the Situation Quickly ............ 215

Comprehensive Workplace Violence Program ............................................. 215

14.11.1 Management Commitment and Employee Involvement ..................... 216

14.11.1.1 Management Commitment .................................................................. 216

14.11.1.2 Employee Involvement ........................................................................ 217

14.11.2 Hazard Analysis .......................................................................................... 217

14.11.3 Hazard Prevention and Control ............................................................... 217

14.11.4 Engineering Controls ................................................................................ 217

14.11.5 Workplace and Administrative Controls ................................................ 217

14.11.6 Post-Incident Response ............................................................................ 218

14.11.7 Training and Education ............................................................................ 218

14.11.8 Recordkeeping and Evaluation of Program ........................................... 218

14.11.9 Evaluation ................................................................................................... 219

Bibliography ....................................................................................................... 219

15 Electrical Safety Standard (29 CFR 1910 Subpart S) ........................................... 221

How Is an Electric Shock Received? .............................................................. 221

Section I: Recognizing Electrical Hazards ..................................................... 222

Section II: Evaluating Electrical Hazards ...................................................... 223

Section III: Controlling Electrical Hazards: Safe Work Environment ...... 224

15.4.1 Use of Flexible Wiring .............................................................................. 225

15.4.2 Use the Right Extension Cord ................................................................. 226

Bibliography ....................................................................................................... 227

16 Fire Safety Standard (29 CFR 1910.155-165) ....................................................... 229

Employee Training ........................................................................................... 230

Fire Extinguishers: General Requirements .................................................... 230

16.2.1 Common Fire-Extinguishing Agents ...................................................... 231

16.2.2 Classification of Fire Extinguishers ......................................................... 231

16.2.3 Ratings for Fire Extinguishers .................................................................. 231

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16.2.4 Fire Extinguishers and Small Hose Lines ............................................... 232

16.2.5 Selection and Distribution of Portable Fire Extinguishers [29 CFR 1910.157(d)] ................................................................................................................. 233

16.2.6 Inspection, Maintenance, and Testing [29 CFR 1910.157(e)] .............. 233

16.2.7 Hydrostatic Testing [29 CFR 1910.157(f)].............................................. 234

16.2.8 Training and Education [29 CFR 1910.157(g)] ...................................... 234

16.2.9 Fixed Fire Extinguishing Systems ............................................................ 234

16.2.9.1 Standpipes ............................................................................................... 235

16.2.9.2 Sprinkler System ..................................................................................... 235

Fire Alarm Devices [29 CFR 1910.165(b)] .................................................... 235

16.3.1 Key Provisions ........................................................................................... 235

Bibliography ....................................................................................................... 236

17 Walking/Working Surfaces (29 CFR Subpart D) ................................................ 237

OSHA-Recommended Good Work Practices .............................................. 237

OSHA Recommendations for Walkways ...................................................... 238

Floor and Wall Openings ................................................................................. 239

Stairs and Stairways ........................................................................................... 239

Elevated Surfaces .............................................................................................. 240

Ladders ............................................................................................................... 240

Bibliography ....................................................................................................... 242

18 Exit Routes / Means of Egress (29 CFR 1910.36) .............................................. 243

Basic Requirements ........................................................................................... 243

Number of Exits ............................................................................................... 244

Exit Discharge ................................................................................................... 244

Locking Arrangements ..................................................................................... 245

Door Swing ........................................................................................................ 245

Exit Route Capacity .......................................................................................... 245

Height and Width Requirements .................................................................... 246

Outdoor Exit Routes ........................................................................................ 246

Maintenance of Exits ........................................................................................ 246

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Lighting and Marking ....................................................................................... 247

Fire Retardant Properties of Paints or Solutions .......................................... 248

Exit Route Maintenance During Construction, Repairs, or Alterations .... 248

Employee Alarm System .................................................................................. 248

Bibliography ....................................................................................................... 248

19 Emergency Action Plan (29 CFR 1910.38) .......................................................... 249

Means of Reporting Fires and Emergency Reporting Procedures ............. 250

Evacuation Procedures and Emergency Route Assignments ..................... 250

Specific Evacuation Procedures for High-Rise Buildings ............................ 251

19.3.1 For Employers ........................................................................................... 251

19.3.2 For Employees ........................................................................................... 252

19.3.2.1 Before an emergency: ............................................................................. 252

19.3.2.2 During an emergency: ............................................................................ 252

19.3.2.3 Upon being trapped: .............................................................................. 253

Procedures for Assisting Visitors and Employees to Evacuate, Particularly Those with Disabilities or Who Do Not Speak English ........................................... 253

Actions to Be Taken by Designated Employees Before Evacuating ......... 254

Accounting for Employees After Evacuation ............................................... 254

Rescue and Medical Duties for Those Employees Who Are to Perform Evacuations ..................................................................................................................... 255

Names or Job Titles of Persons Who Can Be Contacted for Further Information or Explanation of Duties Under the Plan. ............................................ 256

Review of Emergency Action Plan [29 CFR 910.38(f)] ............................... 256

Bibliography ....................................................................................................... 256

20 First Aid Program, 29 CFR 1910.151 .................................................................... 257

American National Standard Institute (ANSI) Z308.1–1998 ...................... 258

Bibliography ....................................................................................................... 259

21 Sanitation Standard (29 CFR 1910.141) ................................................................ 261

Housekeeping .................................................................................................... 261

21.1.1 General Requirements ............................................................................... 261

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21.1.2 Control Pests in your Workplace ............................................................. 262

Storage Areas ..................................................................................................... 262

Drainage ............................................................................................................. 263

Provide safe drinking (potable) water in your workplace ............................ 263

Clearly mark water outlets that are not fit for drinking (non-potable)....... 264

Bathrooms and Washing Facilities .................................................................. 264

Provide Convenient and Clean Washing Facilities ....................................... 265

Eating areas and food service .......................................................................... 265

Garbage and Waste Disposal........................................................................... 266

Bibliography ....................................................................................................... 266

22 Conclusion ................................................................................................................ 267

23 Compliance Checklist .............................................................................................. 269

Required Documentation................................................................................. 269

Items required by law to be in compliance. ................................................... 269

24 List of States Having Their Own State Program ................................................. 271

25 NAICS Code: 6212 Offices of Dentists ............................................................... 273

26 Sample Inspection Statistics and Citations ........................................................... 277

Inspection: 1238196.015 - XXXX, DDS ....................................................... 277

26.1.1 Violations resulting in Penalties ............................................................... 277

Inspection: 1301896.015 - XXXX Dental, P.C. ............................................ 278

26.2.1 Violations resulting in Penalties ............................................................... 278

27 Extract of a Press Release from www.osha.gov ....................................................... 0

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List of Tables

Table 1: OSHA Schedule of Penalties (as of Jan. 2, 2018) .............................................. 23

Table 2: Injury Classification Examples ............................................................................ 36

Table 3: HBV Infection Among US Dentists ................................................................... 44

Table 4: Cases of Documented Possible Occupationally Acquired HIV/AIDS ......... 46

Table 5: Exposure - All Employees ................................................................................... 52

Table 6: Exposure - Some Employees ............................................................................... 52

Table 7: Exposure - No Employees ................................................................................... 52

Table 8: Sections of a Safety Data Sheet ........................................................................ 114

Table 9: Dental Devices that May Contain Hazardous Chemicals .............................. 126

Table 10: Dental Devices Not Covered by the Hazard Communication Standard ... 127

Table 11: Definitions of Physical and Health Hazards .................................................. 128

Table 12: Sample Chemical Inventory Form .................................................................. 129

Table 13: Sample GHS Safety Data Sheet ....................................................................... 139

Table 14: Implementation Schedule Under the Revised HCS ...................................... 140

Table 15: Permissible Exposure to Ionizing Radiation in Restricted Areas ............... 158

Table 16: Radiation Exposure Checklist .......................................................................... 160

Table 17: Basic Fill Contents for Type I First Aid Kit .................................................. 258

Table 18: Workplace Toilet Requirements ...................................................................... 265

Table 19: States with OSHA-Approved State Plans ...................................................... 271

Table 20: Standards Cited Oct. 2017 to Sep. 2018 ................................................................ 274

Table 21: Standards Cited Oct. 2016 to Sep. 2017 ......................................................... 274

Table 22: Standards Cited Oct. 2015 to Sep. 2016 ......................................................... 275

Table 23: Sample Inspection Statistics and Citations ..................................................... 278

Table 24: Sample Inspection Statistics and Citations ..................................................... 280

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List of Figures

Figure 1: 2015 OSHA 3165 Job Safety Poster .................................................................... 7

Figure 2: OSHA Inspection Priorities ............................................................................... 19

Figure 3: Safety Syringe ........................................................................................................ 56

Figure 4: Hand Washing ...................................................................................................... 61

Figure 5: Gloves as part of PPE ......................................................................................... 64

Figure 6: Environmental and Clinical Surfaces ................................................................. 66

Figure 7: Medical Follow-up in the Event of an Exposure Incident (Flow Chart)...... 77

Figure 8: Biohazard Symbol ................................................................................................ 78

Figure 9: Biohazard Bag ....................................................................................................... 83

Figure 10: Sharps Container ................................................................................................ 84

Figure 11: Medical Waste Disposal .................................................................................... 85

Figure 12: Disposal of Regulated Medical Wastes (Flow Chart) .................................... 87

Figure 13: Bacterial Aerosol Elimination .......................................................................... 91

Figure 14: Dental Radiology .............................................................................................. 101

Figure 15: Hazard Communication .................................................................................. 103

Figure 16: Sample GHS Label .......................................................................................... 106

Figure 17: HCS Pictograms and Hazards ........................................................................ 108

Figure 18: Film Badge ........................................................................................................ 154

Figure 19: Ring Badge ........................................................................................................ 154

Figure 20: Radiation Symbol ............................................................................................. 157

Figure 21: Ergonomic Chair .............................................................................................. 169

Figure 22: Workstation Access Zones ............................................................................. 176

Figure 23: Awkward Twisting ........................................................................................... 181

Figure 24: Awkward Bending ............................................................................................ 181

Figure 25: Equipment with Wheels and Handles ........................................................... 182

Figure 26: Plastic Basin Used To Raise Work Surface................................................... 182

Figure 27: Cart with Safety Features ................................................................................ 183

Figure 28: Pushing at a Proper Height ........................................................................... 183

Figure 29: Bed Raised for Cleaning .................................................................................. 184

Figure 30: Allergic Reaction to Latex ............................................................................... 187

Figure 31: N95 Respirator ................................................................................................. 195

Figure 32: Outlet with a Ground Fault Circuit Interrupter (GFCI) ............................ 223

Figure 33: Exit Sign ............................................................................................................ 247

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