All posts by Kev

Beryllium & Silica additives in your lab products!

 

Take notice: Recently, OSHA updated their requirements for dental offices and laboratories with regards to Silica and Beryllium dust. Both are common ingredients of dental materials.  The greatest take away from this article is making sure you check your labels and SDS sheets for Beryllium & Silica additives in your lab products.  Switch to non-Beryllium & non-Silica containing products and take proper precautions for a throughout clean up.  Now, let’s dig deeper into this topic…

Why the concern over these (2) elements? 

Over multiple year studies, dental labs have been found to have a higher occurrence of lung cancers and heavy metal poisoning, not only in the employees but also their family members at home. The tasks that are associated with this increased risk of beryllium and silicate exposure are casting, sandblasting, grinding porcelain, and cleaning/maintenance processes. The main culprit is the tasks is the materials used, they contain beryllium and silica dust. The particles are 1000x smaller than a grain of sand, allowing for them to become airborne and inhaled very easily.  Poor ventilation, respiratory protection, and barrier PPE increase the risk of inhalation. This fine particulate dust also settles on our uniforms, which if brought home, is then inhaled by family members. This significantly increases our family member’s potential to develop respiratory issues, cancers, and chronic health issues. OSHA has implemented regulations that are aimed at protecting dental lab employees and the secondary exposure victims. These regulations are coming under stricter enforcement measures within dental labs and adjacent dental practices. For more information on this please visit https://www.osha.gov/SLTC/beryllium/index.html, this outlines the OSHA findings to include how family members are affected by respirable silica and beryllium dust.

The final rule was published in June of 2017 after a few months delay by the current presidential administration. However, compliance is mandatory and will be rolled out for enforcement in the very near future. The timeline is as follows:

General Industry and Maritime

Comply with all obligations of the standard, except the action level trigger for medical surveillance

June 23, 2018

Offer medical examinations to employees exposed above the PEL for 30 or more days a year

June 23, 2018

Offer medical examinations to employees exposed at or above the action level for 30 or more days a year

June 23, 2020

The time is NOW, to begin implementing programs to reduce or eliminate exposures! You can be sure that dental practices and labs (that have exposure potential) will be audited very heavily. Primarily because these issues not only affect those directly involved but also second-hand exposures are very likely as well. An excellent resource that breaks this down even further is at http://news.nilfiskcfm.com/2016/08/silica-dust-glance-answers-7-faq-oshas-new-rule/

Risk Factors

Without proper respiratory protection, the particles are inhaled into the lungs where they cause scar tissue to build up, reducing the lung’s ability to function. This is a condition known as Silicosis and along with chronic heavy metal exposure and poisoning (from the beryllium used in the materials). This condition can lead to kidney damage, lung cancer, and tuberculosis. Silicosis is an incurable disease that will cause chronic respiratory issues for life. Even if the exposure is stopped, Silicosis can, and usually does get worse. Silicosis is a preventable condition through the use of exposure controls, ventilation systems, and appropriate PPE.

Precautions & Exposure Controls

How do we protect ourselves in regards to silicates and beryllium? The most effective method of control is through substitution. If we can eliminate materials that contain crystalline silicates and beryllium for sandblasting, then the main source of silicosis will no longer be present. A common replacement is aluminum oxide, however, there are many acceptable replacements available. If substitution is an option or not, focusing on ventilation at the production source of grinding is always a good idea.  And this is a Best Practice when crystalline silicates and beryllium are in use With an effective ventilation system in place, any dust that becomes airborne is evacuated before it is inhaled or caught on surfaces. In addition to appropriate ventilation, respirators are also required in case any stray dust is not captured. Respirators require proper FIT testing programs to be in place, either by a qualified member of the team or outsourced to a third party (approved testing methods are outlined by OSHA at  https://www.osha.gov/laws-regs/federalregister/2003-06-06-0 ). At a minimum, the filters on properly fitting air-purifying respirators must be N-100 type as defined in CFR 42 Part 84.179.

Proper Clean-Up, Disposal & Housekeeping Procedures

In addition to the above control methods, some specific housekeeping procedures will help reduce the chances of exposure. Wet mopping ( with disposable mop-heads), wet wiping, or vacuuming with a HEPA filter is highly recommended to keep dust from becoming airborne. DO NOT use a compressed air duster, this will significantly increase the airborne particulates in both quantity and trajectory. Always be sure to double-bag disposable-mop heads and wet wipes into sealed plastic zip-lock bags and dispose of this waste in an exterior trash container.  When these items dry, the particulate matter can be reintroduced into the air.  Best to get them isolated and taken outside of the workplace.

Awareness & Action

With the increased awareness of respirable silicate dangers in regards to dental settings, we can develop protocols and programs to decrease the exposure. Make sure to:

  • Check your lab products, replace all crystalline silicates and beryllium continuing products
  • Replace with non-Beryllium & non-Silica containing ingredients
  • Purchase proper ventilation safety stations
  • Wear proper personal protective equipment (especially respirators)
  • Never eat or drink in the dental lab area
  • Implement proper wet- clean-up with disposable wipes, zip-lock bag and isolate these items into exterior trash immediately

Most importantly, we can help to ensure all members of our dental teams, and their families, have a safe work environment and continued quality of life.

Provided by Dental Enhancements, Inc: 

Gabriel Muller USAF TSgt (Ret.), BA, NREMT, COHC

Heidi Muller  SSgt USAF, EFDA BS 

Jill Obrochta RDH BS 

For more information contact us at:  oshacoach@dentalenhancements.com

941-587-2864

Some additional sources of information pertaining to silicates and beryllium:

https://www.osha.gov/Publications/silicosis.html

https://www.osha.gov/Publications/osha3176.html

https://www.osha.gov/dsg/etools/silica/silicosis/silicosis.html

http://news.nilfiskcfm.com/2017/01/oshas-final-rule-beryllium-cuts-8-hour-pel-90/

https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=9734

New 2017 CDC Infection Control Guidelines for Dental Offices

Hey–Pay attention!  This is important…

It’s not often that we have a radical Infection Control Update—but we are in the midst of one now—

Even if you are a seasoned dental professional with years of experience, you will want to take a look at the New 2016-2017 CDC Infection Control Guidelines for Dental Offices.

Because—– OSHA Inspectors will be focusing intently on these new Infection Control Guidelines when they visit your office!

This new CDC Infection Control Update provides specific changes that will be important for your entire team to know. 

Below is a bullet-point / cliff notes version of the update.  It will be important that review this document—in a staff meeting.

Then make sure to print the CDC Update and fill-in-the-blanks by customizing appendix A & B.  Then save this with your other

Important OSHA documents.

Make sure you understand in detail, these specifics for:

Universal / Standard Precautions:  You already implement these practices with all patients.  These protocols protect the patient and employee from cross- contamination and include the following… Practice these virulently:

Hand Hygiene:  Use soap & water when hands are visibly soiled.  Use Antimicrobial Soaps when a blood-borne path may be exposed. Always wash hands thoroughly, after touching bare-handed objects, before & after treating patients or after taking off gloves.  That is a lot of hand washing!  Use of sanitizing hand gel is not a substitute for hand washing and should only be used when there is no visible soil on hands.

Personal Protective Equipment:  These items must be provided to all employees and worn during clinical and clean up procedures:  Safety Glasses with Side Protection or Face Shields, Surgical Masks (changed—at least one per patient), Well-Fitting / Non-Allergic Clinical Gloves, Puncture Proof Gloves ( for all employees who handle soiled instruments), Ear Protection ( for employees exposed to more than 2 hours / day of Turbine or Ultrasonic Handpieces ), & Lab Coats or Surgical Gowns.

Respiratory Hygiene / Cough Etiquette: This practice will aid in the spread of undiagnosed transmissible respiratory infections. Respiratory Hygiene will safeguard both employees and patients. Post signs for patients to understand proper Respiratory Hygiene.  Have touchless Tissue Receptacles, Masks & Sanitizer Gels available for patients.  Determine an Office Policy for treating or dismissing sick or contagious Patients & Employees. And—Stick to your plan!   Make sure your policy is written down.  ( Use Appendix A & B at the back of the new CDC Infection Control Guidelines for Dental Offices).

Sharps Safety & Safe Injection Practices:  Be sure to toss all disposable Sharps into POINT-OF-USE Containers.  Do not walk around with disposable sharp— this lends for more chance of injury with that sharp object.  The clinician administering injections must re-load and re-cap anesthetic syringes.  Do not hand back in-use syringes to another employee.  Recap with an approved recapping devices or scoop-one-handed technique —in a direction that points away from your body.

Sterilization and Disinfection of Patient-Care Items and Devices: Sterilization & Disinfection of Patient-Care Items requires multiple steps.  Your team must meet-and-discuss the differences between Critical, Semi-Critical & Non – Critical Items to be processed.   Each dental practice must have written policies and procedures in place for containing, transporting, and handling instruments and equipment that may be contaminated with blood or saliva.  (Use Appendix A & B for this too!) If you have the Dental Enhancements OSHA Manual, you will find (2) customizable sections for your Infection Control Written Obligations. 

Environmental Infection Prevention and Control

Written Policies & Procedures for routine cleaning and disinfection of environmental surfaces should also be included in your infection prevention plan.

Cleaning removes large numbers of microorganisms from surfaces and should always precede disinfection.

Disinfection uses chemicals to eliminate microbes—but is not as virulent as sterilization. 

Both Cleaning & Disinfection need to be understood & in a constant process in your clinical areas.

Dental Unit Water Quality

Your Dental unit waterlines promote bacterial growth and development of harmful bacterial biofilm.  These water lines include plastic tubing that carries water to the high-speed handpiece, air/water syringe, and ultrasonic scaler.  Employees and patients can be placed at risk of adverse health effects if water is not appropriately treated.  All dental units should use systems that treat water to meet drinking water standards which is LESS THAN 500 CFU/of heterotrophic water bacteria). Independent water-bottle systems—alone are not sufficient. Neither is distilled water use.  Make sure to treat all dental chair water with a commercial-grade products or devices meet current regulations for quality water.

There undoubtedly is a lot to review!  Remember to download and print the New 2016-2017 CDC Infection Control Guidelines for Dental Offices

This packet will provide a great review and written protocols that you can customize for your dental office.

Got Questions?  Don’t hesitate to reach out to me or my team.  We are happy to provide clarification on the new CDC Infection Control Guidelines and help you with any or your OSHA or HIPAA Compliance needs.

Written by: Jill Obrochta RDH BS

Dental Enhancements, Founder

Compliance Researcher & Trainer

jill@dentalenhancements.com

941-587-2864

IF SALIVA WERE RED

You are a seasoned dental professional, right?  There is no doubt that you know what is considered “Right & Wrong” when it comes to Sterilization & Disinfection, within the dental office setting correct?  Hmmm… Take notice old dog, there are a few new tricks to be learned…

First, let’s travel back in time:  We’ve all sat through that Infection Control Course in Dental School and had that one “ah-ha” moment when we discovered our grotesque but beautiful attraction to manage the flow and flickering of blood & saliva.  For many of us, it was the first time we saw the training video:  “If Saliva Were Red”.  (We have provided the OSAP updated version above (in color)! Don’t let the Spanish title throw you off—there are no words, it is intended for universal viewing)

During our dental education: We read, study and looked deeply at the science behind  Infection Control.  Infection Control Practices become as Foundation as knowing what bur to use for a specific prep or what instruments to use when packing cord.  So how much can Infection Control Practices change? Not much you would think.  But the Centers for Disease Control is taking an updated elevated stance.  In March of 2016, they published their revised Summary of Infection Prevention Practices for the Dental Setting.  If you have not yet looked over this document —you should!  It will impact the way you practice Infection Control Protocols on a daily basis within your dental office.  In fact, I urge you to print it.  (Have lots of paper in the printer—it is 44 pages long).  Pay special notice to the “blue highlighted boxes”.  Then plan to have several staff meetings to get your team familiar, acclimated and “on-task” to implement these updated Infection Control Practices. Why?

The answer:  OSHA Inspectors are focusing on these new CDC Infection Control Practices for the dental office setting.  As an OSHA & HIPAA Researcher & Trainer, I work directly with OSHA Inspectors and dental offices every day to bridge-the-gap between noncompliance and the ever-updating OSHA Protocols.  Did you know that the average OSHA Fine in 2016 was $1700 per infraction?  And Inspectors never stop at just finding one thing wrong within a facility!  Recently, I’ve encountered–more and more—that OSHA Inspectors are using this CDC document, along with their cell phones, to navigate through the halls of your dental office.  They will literally video tape and take pictures of your Infection Control Practices!  It’s upsetting to discover that many dental offices are unaware of these new CDC Updates.  And that can add up to be big bucks in the world of OSHA Inspections.

Yes, cell phones now provide OSHA Inspectors a “real-time technology stamp” on the everyday Infection Control Practices that are being performed within your office.  From improper hand washing to unsafely returning a used syringe to your dental assistant to be recapped, these “real-time personalized stamps” are sure to cost you plenty, unless…

You take the time to embrace this new CDC Infection Control Update.  I compel you to print and review this document closely with your team.  Plan to have several staff meetings to make updates to your current Infection Control Practices.   Then implement the new doctrines into your daily routines.  All dental professionals must keep aware of the changes in infectious disease management and brush-up on our “careful” skill sets.  ” Expertise” has a counterpart: “Shortcuts”.  And in this scenario, short-cuts can mean trouble! Cutting-corners is never the calling cards that true professionals want to be known for…

As the owner of a Compliance Solutions Company, we too have taken the time to really embrace these new doctrines.  Our OSHA Manual has been rewritten to include four new—customizable sections and is currently 345 pages in length!
Written protocols are requirements that OSHA Inspectors will look for immediately when arriving at your dental practice. So, get your office prepared!

I hope you have found this information to be compelling.  Take my Staff Meeting Challenge:  Print these new CDC Infection Control Guidelines; Implement them within your dental practice.   If you find yourself needing additional insight or if you want some guided-help with the process, don’t hesitate to reach out to me or my team for some inspiration or support.  It is never easy to make these changes alone.  We understand that and we are here to help!

Don’t wait until the OSHA Inspector is in your reception room.  Take the time—and get this done!      

written by:
JILL OBROCHTA RDH BS
Dental Enhancements
OSHA & HIPAA made EASY
941-587-2864
jill@dentalenhancements.com 

The Digital Tradeshow Podcast: From the desk of John Stamper – Host of The Digital Tradeshow

Great interview with Jill Obrochta, Founder of Dental Enhancements and OSHA/HIPAA Training Specialist. Jill and her team are getting dental practices compliant and doing it with passion! Listen to it HERE

The Digital Tradeshow is a show about what’s new and what’s next when it comes to the products you are currently using in your Dental practice. Technology is changing fast when it comes to the products of the future so knowing even more about the companies you use is crucial. I will be interviewing companies throughout the industry and getting their perspective on the areas they are focusing on. I will also be providing them an opportunity to share with you “who” they are “why” they do what they do and “how” they are different when it comes to their approach and their mission. Finally, get ready to learn things such as, “what song best describes each company”, as well as “what special talents some of their employees have” as we venture into the 60-second lightning round!

Listen to it HERE