Safety, it’s No Accident! OSHA Training for Dental Professionals

Webinar

Outline: 

This course contains the latest information on OSHA standards for the dental practice set forth by Occupational Safety & Health Administration. It is intended to satisfy the annual required OSHA training for dental practices. Administrative team members are encouraged to attend to further strengthen the team approach to safety in the workplace.

Learning Objectives:

• List the OSHA standards that apply to dental practices, interpret the importance of each standard. List real world examples of OSHA violations that have occurred in the United States within the last 5 years.
• Provide a list of OSHA responsibilities specific to employers and employees.
• Define the Bloodborne Pathogen (BBP) standard, identify BBP basic requirements, and discuss the modes of disease transmission most common to a dental office setting. Define the Hazard Communication standard.
• List the standard’s basic requirements, interpret each requirement including successful implementation of engineering controls in a dental office setting.
• Define the Ionizing Radiation standard. List the standard’s basic requirements, interpret each requirement including successful implementation of engineering controls in a dental office setting.
• Define the Ergonomic Hazards & Prevention standard and Exit Routes standard.
• List the standard’s basic requirements, interpret each requirement including successful implementation of engineering controls in a dental office setting.

 

Transcript

Good evening, everyone. Welcome to tonight's presentation. I am Dr. Lisa Germain and endodontist since 1981 in private practice in new Orleans, Louisiana. However, tonight I am speaking to you in my role as clinical director of DC Dental company, and as such my primary responsibility is to bring you by monthly agenda free continuing education webinars on a variety of topics given by educators and experts around the world. Now I say by monthly, but recently they have been, bi-weekly like twice a week. And so we are very excited tonight to to be giving our second webinar, actually back to back with our water water source webinar, because they kind of go hand in hand. However, let me just give you some housekeeping details. And I also want to say, because DC Dental recognizes the importance of giving back to our profession. They have sponsored this program for six years and recently it has just been, our attendance has been wonderful.

And so I also want to thank the audience enormously for your support and for attending, because it means an enormous amount to us. Okay. First of all, you will receive one and a half hours of CE credit for tonight's presentation. You will get that by email from DC Dental. If you don't get it in 24 hours, please check your spam folder first. And then if you still don't have it, please go to DC Dental. Well, email them@clinicalatdcdental.com and they will send it to you. Now, if you have any glitches in your audio or your video, please close all of your windows and reboot your computer. We don't have an enormous amount of control over the individual computer systems. There is a question box that you will see on your control panel. And if you have a question for tonight's speaker, we will be doing a Q and a section at the end of the presentation this evening.

And so please ask them in that box and we will review them a little bit later on. Now tonight's presentation will be recorded and archived like our other presentations. You can receive self study credit for for any of them actually, by going into our archives viewing the course and then contact EEC dental at clinical, a DC Dental.com. It will send you a short quiz and subsequently your CE credits. Now we don't make the rules about the quiz. That is an AGD thing, and that way you do get the certification. That actually means something I just want to thank the team at DC Dental, who has spent the better part of the last two months, scouring every available resource, domestic and international with the intent to build pipelines, to acquire the necessary PPE for the dental profession. Our programs recently have focused on getting our profession back to work, and tonight is no exception.

We are so very fortunate to have India chance with us. She is an OSHA expert and as well as an expert on infection control in the dental office, which as we know is such a timely topic for us. She is a registered dental hygienist and independent compliance consultant who provides CE for dental professionals to improve their knowledge on infection control and safety in their workplace environment. Nationally, she has trained dental practice teams to implement and strengthen their dental safety programs, as well as provide one-on-one coaching to many dental practice owners. She is leading the leading dental compliance speaker for the Washington DC metropolitan area, and actually India. I've heard your name all over the country mentioned just so you know, that she certainly currently served two truths and she's been really busy folks. So this is actually we we had arranged for this before this whole pandemic thing happened. So very fortunately it was timely for us. She currently serves as the KOL infection prevention speaker for dense supply Sarona dimensions of dental hygiene brand and back.

So they're a C a S O P member. Okay. in federal consultant for Maryland state dental association, infection control lead Southern Maryland mission of mercy, mid Atlantic Panda abuse, awareness of dental professionals, board member, and tonight's course is safety is no accident. OSHA updates for the dental professional India. The floor is yours. We are very excited. Okay. Yay. Thank you so much. I am glad to be here. I just want to thank DC Dental for having me. That was such a wonderful introduction. I'm very excited to be sharing this information. It's very timely. And so hopefully, you know, you might hear some things that you already know, but my hope is that you receive some new information and as we're going through all of this information you know, just think about what's happening in your office or what's going to happen.

And hopefully you can gain some new understanding and new nuggets so that you can strengthen your safety culture in your dental practice. So I am going to get started here and I have to share this. This is the bio and you guys already heard about that. The only really important thing on here is as far as disclosures, I tend to recommend a certain products or, you know, I have pictures throughout my presentation and those are really just for illustration purposes only. I don't have any you know, monetary relationships with anybody. So here are our objectives tonight. We are going to define and its mission. We're going to talk about all of the current OSHA standards that are in place. And then towards the end, we're going to talk about HR considerations and all of the OSHA updates or the guidance for COVID-19. So let's get started here.

As we travel down the road of safety, there are a couple of questions that you want to ask yourself, regardless of what role you have in the dental practice. It is important for us to take a look at how important is employee safety to the dental industry. Now that we've been going through this pandemic, you know, it's been in the news, it's the forefront, it's, you know, everybody's thinking about it. And so you want to kind of see where it fits into your role in the dental practice, as well as how important is it to you because you are going to be going back to dental offices where you're going to be dealing with different mindsets. So some people are going to have a lot of buy-in. Some people might have some pushback. And so, regardless of what you know, mindset you have just think about, you know, how important employee safety is to you in your role in the dental practice.

So where we need to start is who is OSHA. Now, a lot of us have found out who OSHA is through the pandemic. But I do like to emphasize that OSHA really focuses on employee safety. We've heard a lot of these acronyms. We've heard CDC, we've heard who we've heard OSHA. And so all of them have different missions. Some of them are legal entities and some of them are organizations or departments of the government that make recommendations. So the CDC makes recommendations. OSHA is actually a legal entity. They make mandates and they submit legislation for law. And their mission is employee safety. Cdcs mission is really public health. So that would be patient safety. The thing is with OSHA is that they do look at the CDC recommendations. They take some of those recommendations and they create the mandates and laws that we're going to hear about. So you might see some information that you learned in an infection control course here tonight. And that's where the overlap comes in between the CDC and OSHA. So OSHA is the occupational safety and health administration started in 1970. And the mission is to make sure that the workplace is safe for everyone, not just employees, but also for the employer. And the employer has to make sure that they are adhering to all of the mandates that are in place.

Now, some of the time, a lot of people that I train, they work in practices where they don't, you know, deal with a lot of injuries or hazards in the practice. They, you know, they work in a practice where you know, they haven't had a needle stick injury in 15 years. Unfortunately that's not every dental practice. And so across the country, I always like to update and share what's actually happening in some of the dental practices. And so is public information. You can get it off of osha.gov, but as of nine 2019 here were just some examples of dentists that were fined for OSHA violations. And some of the violations are listed here, not having a bloodborne pathogen standard. We're going to talk about that tonight, hazard communication standard. We'll talk about that. That has to do with the chemicals that are in the practice improper respiratory protection.

That's important more than ever now. And I'm going to talk to you guys about how you can receive a respiratory standard plan that does need to be added to your OSHA binder now. And then another one was failure to provide medical care followup. And so what happens during an ocean section is that in a complaint is made and then to the OSHA office, and it can not be anonymous. They do not accept anonymous complaints. What they do is they take that complaint and they do like a preliminary investigation to make sure that it's valid and make sure that it's not, you know, somebody who's disgruntled that just doesn't like you, if they determine that it is valid, then they will present to your office. They will come in. Most of the time they have a badge or they'll have like what they call like an OSHA warrant.

And they will request to see the practice owner. Now whoever is at your reception desk, you'll want to make sure that you train them to, you know, come get you as the practice owner. And then you and the OSHA inspector will be, you know, in a more private setting, they will go over the complaint with you. And then they will let you know that they're going to conduct an inspection. You are allowed to have an employee walk with the inspector. I definitely recommend that you have somebody walk with the inspector to answer any questions. Sometimes things can appear a certain way. When in fact, you were really trying to make good faith efforts and you thought you were doing the right thing. And so having an employee there to explain this to the inspector sometimes can give the inspector a little bit of understanding.

Now, I will say with that team member, whoever that's going to be, make sure that they do not give more information than what is requested. So you're only going to answer the questions that are asked. You're not going to volunteer a ton of information because you don't want to cause more problems for yourself. Okay, you're going to walk around with the inspector. The inspector is going to finish. They're going to go, come back to the practice owner. And then they're going to discuss everything with you. If in fact, they find violations, depending on the degree of violation, they will either close the practice right there, or they will give you a, what we call like an action plan. And you have a certain amount of time to complete the action plan. They will return, and they will make sure everything has been completed. If in fact, you do not adhere to the action plan and complete it.

That is when penalties are, you know given to the practice owner. And the way that OSHA works is per violation is actually a penalty of fine. So they range between 13,000 up to 134,000 and that's per violation. And it really just depends on what the violation is. That's going to determine what type of fine that you're going to receive. So that's it. In a nutshell, we're going to go over all the information that you need to know. So this never happens to you, but I do like to kind of let people know what to expect. If they ever experience an OSHA inspection. Now we start with the different roles in the practice. The whole team goal is to provide the safest dental visit possible. Okay, for everyone in the practice, we put an awful lot of emphasis on patient safety, but it's time that we also look at our safety as well.

So from the time you come into the office, to the time you leave, it has to be safe, right? And so we break that down into roles. So as a leader, if you're a leader here tonight, or you hold, whether you're the practice owner, if you are the lead hygienist, lead da office manager, whatever leadership role you hold your responsibility is to make sure that you communicate to the team concisely and make sure that it's clear, okay. People have to understand what their role is, what they're supposed to do, what the tasks are, and then what the safety protocols are. They have to you know, be clear on how they need to, you know perform those duties, right? And so you have to have an open door policy as a leader. Okay. Your team has to be able to come to you and make sure that they can talk to you about anything.

Even if they kind of notice a protocol that could be more efficient having an open door policy so that they can come to you and you guys can work it out as a team to say, you know what, let's implement something else to make this more efficient so that we still stay compliant. Team structure is important. Every single role needs to be trained. And so we're going to talk about that because moving forward, you might have some team members that are going to be doing some tasks that they've never done before. So for instance, some of your administrative team members, they've never used disinfectants in the past. So they need to be trained on what type of PPE to use when they're using the disinfectant. They also need to be trained on how to use the disinfectant. You know, if you have a team member who has a dual role, maybe their admin and maybe their clinical team role right now that might not be feasible for you to do.

And so team structure very important, making sure that's clear, making sure it's organized for everybody communication. We talked about that. It has to be clear and concise, a situation awareness, knowing what's happening in the practice on a daily basis, you know, it's going to be important that you foster teamwork, you know, as people are walking down the hall, Hey, do you need anything? What do you need? Can I help you with that? Oh, let me help you. So you don't hurt yourself. Things like that. You have to make sure that people are communicating and everybody in the practice kind of knows what's going on. Team support. I just talked about that. And then personal health. This is really a big one. This is our very first barrier to preventing any type of hazards in the workplace, as well as disease. So our personal health, how strong is our immune system, that's going to be your first barrier to staying healthy in the workplace and staying safe, right?

Are you getting enough rest? Are you stressed out? If you are stressed out, what are you doing? Do you exercise? Do you go ride a bike? Do you read, what do you do to kind of deal with that stress? So you're not bringing that to the workplace. Again, we're going to be going back into workplaces where there's going to be a lot of perspectives. A lot of people are under different stress levels. There could be some financial strain. There could be emotional strain. There's a lot going on. So mental health is super important. It does affect your personal health, which in turn will affect, you know, how safe you are performing any of your tasks in the workplace. So personal health have to make sure that you have some self-care scheduled in somewhere on a regular basis. So OSHA standards, this is where we're going to start, and we're going to really get into what is OSHA expecting us to do moving forward.

And I'm also going to talk a lot about the OSHA standards that have been in place since the eighties, since the HIV epidemic. And so hopefully you'll be able to, you know, like I said earlier, take some nuggets and really strengthen your safety culture in your practice. So what is an OSHA standard mandated rule? Okay. And regulation for every healthcare setting. And then these are our areas of focus. We're going to break each one down tonight. And again, if you have any questions, put those in the Q and a, or the chat box, and we're going to kind of do a, a lightning round at the end. So I can get these questions answered. But let's get started with our first area of focus. And that's your training and it's required annually. So OSHA requires that you have annual training. If you're a dental practice owner have to have it on the books every 12 months, it has to be done by a knowledgeable trainer.

So if you have your team on here tonight, this is part of your training. This is considered you know, a training for your team. Okay. It has to have an interactive Q and a, which we're going to have at the end of this. And then we have to have a training log for it. So for those of you on the line tonight, if you have your whole entire team on here for the training at the end, I'm going to give you a link. You're going to visit that link and you're going to download a training log. You're going to print that out and you're going to fill that out and that's going to go into your OSHA binder. Okay. also part of the training is you have to have an OSHA binder. Okay. And we'll talk about what, you know, components are needed in the OSHA binder.

And then you also have to offer training, onboarding, meaning whenever you hire someone new, it has to happen within 10 days of employment or whenever updates occur similar to this. Okay? So we have some new updates. It's still guidance, but it's good to have your team trained on what the COVID-19 guidances. If in fact, OSHA does decide to make an actual standard for infectious disease. Then you will have to do another training on OSHA in that standard so that your team is aware of what the new updates are. And this is all required by OSHA. It's been in effect. Gosh, since you know, 1980s, like I said, so it's still still on the books, pre pandemic record keeping that's. The next area of focus. Inspectors are always going to ask you for your records. Okay? So like I was talking to you, I talked to you through like what an inspection looks like.

And so the very first place that most inspectors, whether it be an ocean specter or a dental board inspector or health department inspector, depending on what state you're in and who conducts your inspections, they're always going to start with like the administrative area and that's your recordkeeping. And for those who have never heard of it, if it's not written down, it never happened. And that's how inspectors look at your record keeping. And I will say this, you want to make sure that you're super organized with your record keeping, because if you are not, it sends a red flag to the OSHA inspector, or really any inspector that if you don't have your record keeping area and this, you know, if you don't have this organized, what else do you not have organized? So they're going to be extra cautious. And they're going to be very nitpicky a lot of times with what they're looking at when they go to observe the rest of the office.

So make sure take this time. This is a great time to make sure that all of your record keeping is in order. So the most common records that they ask for are a log of work-related injuries and illnesses, annual staff training, which if you're on here tonight with your team, this would be that office evaluation. We're going to talk about how you assess the hazards in your practice, spore testing. That's a big one. They definitely look at that. And they're now siting for malfunctioning sterilizers. Some ocean specters are the reason being is because if a team member performs hand hygiene and then goes to take out cleaned or sterilized instruments and they grab them. And one of the instruments happens to have broken the pouch in some way. And then a team member grabs that. And it's, you know, some type of stick with a sharp instrument.

If the sterilizer wasn't functioning properly, that means those instruments were actually contaminated. And then that causes a hazard for your team members. So they will cite you for a malfunctioning sterilizer medical waste. You have to have some information listed in your OSHA binder. It has to be a customized, there are certain areas in the OSHA binder that have to be customized. This is one of them you have to list out who comes to pick up your medical waste, their address, and their phone number. And then HPV is your hepatitis B verification. We're going to talk about that, but you have to have verification for every clinical team member. And if you need any type of logs or as far as work-related illnesses or injuries, you can get them off osha.gov. It's form 300 and form 3 0 1. Okay. That's form 300 form 3 0 1. The other thing is, might want to visit osha.gov and find out if your state has a state OSHA plan.

I personally live in Maryland. We do have a state plan. It's called motion. So Maryland, occupational safety and hazard. We have to do a couple of extra things sometimes regarding we have an extra poster that we have to put up that's mandated. So each state has their own type of plan. Now, not all states how the state plan, but you can go to osha.gov to find out. I think it's like 28, 29 states that have a in OSHA plan. And you can find out from your OSHA office, what else you have to do? Everyone has to have a medal on employee medical records. So as a dental practice owner, every person that you employ has to have this, it has to have their name and social security number. If they are a clinical team member. So any type of clinical role for those dual role employees, they have to have proof of hepatitis B, vaccination or declination.

We'll talk about that. If they've ever had an injury and they had to go get post-care, follow-up the doctor that treats them will send a written letter of opinion. And, you know, sometimes it'll, they'll send like medical results depending on what it is. They have to be careful with HIPAA. But if you do receive that this, that would go into your employee medical record and then any type of incident forms, that's that form 3 0 1. That's going to be where the employee or the team member writes down details of the actual incident. That's going to go in the employee medical record. These medical records need to be maintained for 30 years and they have to be kept confidential as the employee, though, they are allowed to take a look at their own medical record. Anytime they want to, they can't look at anybody else's for HIPAA purposes, but they can look at theirs if they want.

And I just had a situation today where a practice owner purchased a practice from an older dentist and the older dentists did keep records, had employee records, and you are supposed to keep these records for 30 years, like the life of the life of employment plus 30 years. So she's going to have to keep all of that. So I had to inform her of that today. So if that's the situation that you're in, you have to maintain all of those records. If you happen to purchase an office where they had nothing done, then you're responsible to make sure that you implement this in your practice, moving forward. If you happen to ever get, you know, involved in an inspection, you would just let the inspector know that the previous owner had nothing. You know, and I'm the one that established everything. You're mandated posters.

So you have to have the OSHA workplace poster. It's in this picture on the left there, you can actually get this for free, right? If you don't have this, you can get it for free. It's, you know, workers' rights employee rights. And so you can get it for free on osha.gov. It's you're required to display it. Some states have an additional poster. That's like me in Maryland. We have an additional poster that we have to post. So you go to your state plan to find that out the department of labor, there are certain posters that you have to have regarding like minimum wage and all of the workers rights and just different things like that. Most of the dental practices, it's a big, huge poster that they, that they post. You have to make sure that that's updated. The one that they added during COVID 19 is the families first coronavirus response act that is required to be posted.

You literally can Google F F C R a poster. It is a it's as big as a sheet of paper. You just print it out and print out in color or black and white, whatever you want. And you post that. It has to be posted in an area where all of your employees go. So I recommend that the OSHA poster, the department of labor posters, those be posted like in your lunch area, your lounge. I do have some clients that posted in the bathroom because everybody goes to the bathroom. And so yeah, you just have to make sure that everybody can see that. And then CDC has a few posters for COVID-19 and infectious diseases. The two that I've been recommending are the one that has, it's got a yellow background and it has two people on it. And it's all about the proper PPE for healthcare facilities.

One side is your N 95 respirator and all of your gear for that. And then the other side says, alternate PPE. And we're going to get into that, but it's the level three mask. And then the chin length face shield that I would post you know, in the clinical area where all your clinical employee team members can see that. And then there's another one that you should post on the front door, on the outside of the door, where it's got a stop sign. And it basically says, stop. If you've experienced any of these symptoms and call this number, you can reach these posters on PR you want to Google print CDC, print resources. And if you Google that, you just, it's the first thing that pops up and you can get all the posters that you need from the CDC and then cough, etiquette sign.

OSHA has mandated this for a long time. This is pre pandemic. So it's been, it's been mandated, I think since like 2007 or 2008 this has to be posted in the reception area. It's just training your patients and educating your patients on how to perform proper cough etiquette. You can get a cough etiquette sign from the CDC website. You literally just search cough, etiquette poster. It'll come up. It's as big as, as sheet of paper, print it out and put it in your reception area. Okay. And the next area of focus we're going to talk about is the bloodborne pathogen standard. And so I'm going to try to play this video. I'm trying to find there's my mouse. I'm going to try to play this video for you guys, but this is going to give you an overview of the bloodborne pathogen standard. And then I'm going to kind of break it down for you each area.

Okay. So the bloodborne pathogen standard, this has been in effect since the eighties, since the age HIV epidemic. Okay. And so this really deals with contracting any type of disease through a bloodborne route. Okay. So that is why you're going to hear some of the information that deals specifically with that type of disease. We do have airborne routes, and that's why we're having to do a lot of these new protocols right now, but this is dealing with the bloodborne pathogen standard. Like I said, that's been in effect for a very, very long time. And here are the basic requirements for the bloodborne pathogen. Okay. It's record keeping, which we talked about have to keep your records, bloodborne pathogen training, which we're doing right now, a written exposure plan. I'm going to talk about that. That's found in your OSHA binder, hepatitis B vaccination, no cost to the employee, providing personal protective equipment use of labels color-coding and then proper containment of regulated waste disposal.

So we're going to go through each one of these. So your written exposure plan, this is a required document. It has to be customized, and it provides specific guidelines. This is going to be found in your OSHA binder for those who do not have an OSHA binder and you need, or you need to update one. I definitely recommend the one that's provided by the ADA. If you're an ADA member, they it's like 50% of what you would pay if you're a non-member. So the reason why I liked that one is because they keep it updated as far as you know, from year to year. And it has all of your template documents that you'll need to have in case someone gets injured. It has different safety logs in there. So it's pretty comprehensive. And I really, really like it. And it's very user-friendly as far as where you need to customize it.

Okay? But this particular exposure plan is going to go through all of the guidelines on what happens. If you get some type of exposure from a needle, stick exposure, or sharp instrument or chemical exposure, your hazard assessment certification. This is part of the bloodborne pathogen standard. It's a mandated annual assessment and it determines the hazards. And so what you have to do on an annual basis is you are going to have to take a look at all the roles in your practice, okay. And their tasks, their task list. Okay. Now, if you get the ADA OSHA binder or any other kind of binder, most of those binders have a section where you need to classify, who's doing what, so you would write down dentist, and then it you're going to list the task list. You're going to write down dental hygienists, dental assistant admin role takes out the trash, or, you know, if the dental assistant takes out the trash or the hygienic, whoever's doing what that needs to be listed in there.

And then you have to examine the engineering controls to ensure effectiveness. So what that means is any type of device that you have implemented to protect someone. So for instance, if you're using a recapping system for your needles, who's using that is the dental assistant recapping the needles is the dental hygienists doing that. Are you doing that? Do you have a particular device? Are you using the one hand scoop method? What are you doing? If you have a device, you have to look at that. You have to kind of have a team chat about it and ask, are these devices working? You're going to look back at your log of injuries. See if anybody had a needle stick for that year and say, okay, we've had like three or four needle sticks. What's going on? Do we need more training or do we need, are we using the one hand scoot method?

And maybe we need to get a device. So you have to do this annually. I recommend that you do something like this during a team meeting. It doesn't have to be long and drawn out, but it definitely needs to be done on an annual basis and with the whole team so that you can receive feedback, or you can give feedback, maybe you're doing a protocol that could be more efficient. Maybe somebody attended a dental conference and they found a device that's actually better and can keep everyone safer. So you want to hear about that kind of information. And we're going to talk about that too, because there's another additional annual hazard assessment that you have to do a little bit later on. And I'll talk to you about that. When an exposure occurs, these are the types of exposure, okay? Splashed eyes, object splash to non-intact skin or stick, right?

And so what do we do next? What happens? So OSHA says, this is how you manage an incident. First. You want to make sure that the person receives first aid. So for those that don't have a first aid kit, you want to make sure that you have a first aid kit moving forward, right? Then the person who experiences the injury needs to report it. So you need to have an established protocol on who is going to be the person that receives the reports. Is that going to be the practice owner? The office manager is that your, your infection control coordinator, your safety, you know, your OSHA safety officer in the practice, who's going to receive the reports. Then you have to make that announcement to everybody so that your team knows who do they report to. Then you have to document that person that receives the reports.

Most of the time is going to give the documents, those, those logs, those incident forms on that incident form. If you could use the one-off OSHA, it already has all this information. It tells the person, you know, what date and incident to, you know, fill out now source patients. So some of you might live in states where it's mandated and it's a law that the source patient receives a blood draw. If it happens to be a needle stick injury with a contaminated needle, I personally live in a state where it's not a law. So we have to ask our patients if they would be willing to go with the employee, to the medical care follow-up facility and a blood draw. And in my state, they can decline. They don't have to go. So you have to find out what type of state you live in.

Okay. if you live in a state where it's mandated, then it is, it has been suggested by malpractice attorneys that you have some type of consent form as part of your new patient packet and that paperwork. If, if, if you work in a state where it's not mandated, then you're going to have to have a conversation with that particular patient. And they would follow the employee to get the blood draw post-exposure management. There is such thing as the golden hour. So as soon as an injury happens, you want to try to get the employee or you as the employee, want to get to the post care management, the followup, the medical facility within 60 minutes. Okay. So when you are setting up your medical care, follow-up referral, you know, as a practice owner, you want to look at the distance of where this is from your practice.

You don't want to have to send somebody to drive an hour and a half away. So there's a couple of different options you have. If you have a colleague that is, you know, could handle any type of first aid situation can they give, can they do a blood draw at their office? Also, can they provide rapid HIV testing? There's a couple of things that they have to be able to do. It can't just be a primary care doctor. Who's just doing checkups. That's not gonna fly with OSHA. Okay. the second option you can do is the hospital, ER you know, a lot of practices use them. The only thing you want to consider is I would recommend you make a phone call to them, find out if they would bump your person to the front of the line. Does your team member have to wait three hours?

If the ER is busy? Like what does that look like if they happen to get an injury and is busy at the hospital, the last option, which this is what I recommend is you contact an urgent care facility. That's close to your practice and find out if they have a program. I work in a state where we have a chain it's called patient first and they actually have a program for employers and you speak to, they have a person that's dedicated to this program and that's all she does. So when you want to set up something like this in your, in your practice, you call her and she gives you an account number. She sets it all up. She provides you with a form that all you do is hand that to the employee. The employee takes that with them to the urgent care.

They hand that to the front desk there and then everything else is taken care of. And they're just treated with, you know, their initial medical care. So that's what I would recommend because it's much easier. And then they bill you as the employer. If there's any costs. Now, an employee can decline this at any time. If an employee does decline this, they need to sign a declaration form. And that should be in your OSHA binder. If you order it from the ADA, if you've ordered it from another company, just thumb through your OSHA binder to see if you have that. If not, you can, you can really, you can Google it and you can get an employee declaration for medical care. They sign that, that goes into their employee medical record. And then within 15 days after the incident, you, as the employer will receive a written letter of opinion, that just lets, you know, if the patient can return to work, I'm sorry.

If the employee can return back to work or not. And then that goes in their employee health record. These are the suggested items in a first aid kit. It's not mandated, but having these from a risk management standpoint really, really helps you. Your goal is to keep the patient or keep the team member alive. If in fact it's a life threatening injury or hazard that happens. And so all of these, a lot of them come in those larger, more comprehensive first aid kits, Narcan you might have to get from your local health department. I know in our DM I'm sorry, DMV or Washington, DC, Delaware, Maryland, Virginia area you can call the local health department and a lot of them will give you a free dose of the Narcan. And most of the time it's a nose spray or it looks like an epi pen.

They give you directions on how to use that. Some of the other items, if you don't have them as the dentist, you can call the local pharmacy and find out if you can get a couple of these because you, you do have the license to prescribe your hepatitis B vaccination. That's another area of the bloodborne pathogen standard. Now the CDC has recommendations for all health care providers for all types of immunizations. Hepatitis B is the only immunization that OSHA mandates and is required. It's federal law that all of your clinical team members, anybody that treats patients is supposed to have a verification that they've had the hepatitis B vaccination series. So if you happen to hire someone that does not have it, or they're brand new to dentistry and they've never had it, then you have to offer it to them at no cost within 10 days of their employment.

Now, if you have somebody on the team and you know, they've had it years ago, they have to document that they've had it. And what you do is ask them to ask their primary care doctor. If they have proof, if it's a situation like me, where I've changed doctors and I have no record like specific record, you know, my current doctor doesn't have it. Then OSHA says, what you can do is literally take a piece of paper. You're going to date the paper. You're going to have the person write out a quick paragraph. Hi I, India chance have had previous vaccination in March, 1994 at university of Maryland dental school. I completed the series and I was fine. I am declining to have the series currently and I'm aware that I can ask for it at any time period. I sign it and I dated again and I hand it to my employer.

And then as the employer, you're going to put that in their medical record. Okay. That's if they've had previous vaccine and they can't get proof, okay. But they know they've had it. If the, if the team member has antibody testing and it reveals immunity, that's a small percentage of the population in America, but it does happen. I met somebody actually, who was in my course that that happened with, and then medical evaluation. If it's contraindicated now again, you can decline at any time. You just have to fill that out, even if you've never had it and you don't want it, you have to fill out a declaration form. And in OSHA binders, they tend to have ADA or third party. They tend to have just a straight up declination form that you just don't want it at that time. And you can change your mind, but that's the form that you would fill out if you've never had it and don't want it if you've had it and don't want it, you have to fill out that paragraph. Okay.

And the next area of focus in the bloodborne pathogen standard is personal protective equipment. Now, the, I did talk to you guys earlier about the very first barrier of preventing hazards and disease is our personal health, right? So the second barrier of preventing, you know, hazards and disease is PPE, but the first step of PPE is hand hygiene protocols. So I want you guys to take a look at this video. It's a quick video it's done by the ADA. I think it's really great. It just is a great reminder for us on what we need to be doing regarding our hand hygiene protocols. So take a look.

Okay. So quick reminder for everybody regarding hand hygiene protocols, there's a couple of things that I like to add to this video. One is if you are someone that uses alcohol-based hand ropes, you need to really make sure that you pay attention to the dosing instructions. Because a lot of times people do what I call a drive by where they're walking by and they, they don't even stop at the hand sanitizer. They don't pull it, you know, all the way back, the way you need to or push it all the way back to get the right amount, or they just kind of pumping go really quickly. So you need to make sure that you're paying attention to the manufacturer instructions for use on the dosing instructions. Now, if you are using an alcohol-based hand rub where it doesn't have any instructions, then you'll, you'll, you know, open up your hand and think of a Hershey kiss, right?

In the middle of the Palm of your hand. That's the amount of hand sanitizer that you want to use? The alcohol-based hand rub. I know it sounds like a lot, but that amount is the typical amount that most of the manufacturer instructions for use tell everybody if they're, if they have dosing instructions and it's also enough for you to make sure that your hands are thoroughly wet and you do have to rub until your hands are dry. The other thing about hand hygiene is the nail Polish and the fake nails, the artificial nails. So there are studies that, you know, say that cracked nail Polish or chipped nail Polish is an, a great recipe is a great reservoir for bacteria. Okay. So if you are going to wear a nail Polish, it needs to be fresh at all times. Okay. Because we don't want to have any type of bacteria or anything housed on your hands because sometimes you might, you know, perform hand hygiene, but they're not perfectly clean the way we need them to be.

And then you go and you're, you're touching, you know, different things around the office, as far as patient care items, you know, the disposable two by twos or something like that. So make sure that that's, you know, fresh at all times. The other thing is the video did mention keeping your nails very short. So that leads me into the artificial nail conversation. You're if you're going to wear artificial nails or anything like that, they need to be very, very short because artificial nails, there are studies that again, they're great reservoirs for bacteria. The other problem with long nails and putting on PPE, your gloves in particular is you end up having to wear gloves that are too large for you to fit over your long artificial nails and wearing PPE, especially gloves that is too big for you can definitely increase a hazard.

Now I'll tell you a story. I was in a practice. The dental assistant was wearing gloves that were too big for her for another reason, not because of the artificial nails, but it regardless they were, it was too big for her. Okay. The gloves, she was contouring a temp crown. Now, as she's contouring the temp crown, the excess part of the glove that she was holding the temp crown with got wrapped around the high-speed handpiece. She lost control of the high-speed handpiece and actually drilled into her thumb because the gloves were too big. So you must make sure that you're wearing gloves that properly fit you. And with artificial nails, that's really impossible. So if you're going to work in a clinical role, you're going to have to have proper hand hygiene. And that means shorter nails. Okay. So I just like to put that out there for everybody.

Okay. And I think we've all gotten used to not going to the nail salon with COVID. So hopefully nobody's really mad at me for saying that. So we talked about hand hygiene protocols, so that was kind of the first step in our PPE. So here we are at PPE and what is mandated? What do we have to wear? And so this has been in effect for a very long time. Since, you know, the eighties gowns, aprons masks, or face shields, protective eyewear and gloves, it's mandatory if you're treating patients. And then, like I said, it all has to fit properly. Some of the PPE can be provided by the employee themselves. So that would really only consist of your loops. Dentists or practice owners are not required to purchase anybody loops, but they are required to give you just basic protective eyewear. Okay.

All of the other protective equipment, like your gloves, your gowns face shields and all of that. Yes. We practice owners do have to provide that. So let's break it down. So here we are with gowns and scrubbed jackets. Now I know we're in, you know, the COVID-19 updates and guidance and, you know, recommendations and everything, but it, regardless the gown or the jacket has to be fluid resistant. It is recommended that if you, because we're in a PPE shortage right now, if you can, you should transition to reusable, gowns and jackets, because there's just not enough. There there's such a shortage. There's not enough. The other reason why the CDC recommends it is because if you're having to change it more often, a lot of those disposable gowns that are really long, they have ties that tie around your neck and tire around your waist.

If you have to take that off, let's say to go to the bathroom, but you're still treating the same patient. You're not going to wear that to the bathroom. Well, when you go to take that off, you break that string. And now you, you go back, you know, you come back from the bathroom, you put that gown on. It's not going to fit you properly and protect you properly. So that's why they're saying go to reusable. K. If you're going to go with reusable as the employer, you are responsible for laundering. So you can use a third party if you have a washer and dryer on site. But you are not supposed to be taking it home. You are only responsible to provide the outer most layer, which is your gown or your scrubbed jacket, your lab jacket. You are not responsible to provide a scrub top and scrub pants.

And if you want to, that's great and kudos to you, but that's not what the OSHA language says. Okay? some practices now are allowing their employees to wash their S their scrub tops and pants at the office and keep them there just due to this whole COVID-19. We are going to talk about that, like leaving your clothes, either at the practice, if you have a washer and dryer, or how you take them home to launder them. But if you can, you know, try to leave everything in laundry there if you are not laundering and you don't have a washer and dryer on site this is to the employees. What you would do is you would, you're supposed to come in your street clothes. Now you're supposed to put on all of your, you know, your fresh scrubs put on your PPE, go through your day, treat your patients.

When you're done, dispose of everything, take off your scrub top and pants. If you're taking it home, it goes into a bag. And then when you get home, you wash it in your washing machine, on hot cycle with color safe bleach. The Corona virus is a very weak virus. Bleach is going, as long as you follow the manufacturer instructions for use, you are going to kill the Corona virus, okay. With bleach. And so, but you have to follow the manufacturer instructions for use. There is no need to run your washing machine again or anything like that. You will be fine with that. So the other thing is the CDC has recommended and it does make sense to extend the length of the jackets to cover the thigh area. Traditionally, a lot of dental clinicians, they were waist length jackets. The concern with that is, is when you're sitting and all of the aerosols come up and then it falls down or droplets fall down.

If your thigh area is not covered, and you're wearing those home, then you get home and your child, or your pet, or your spouse, or, you know, whatever they grab on you or hug you or something like that, they lay their head on your lap and you're still wearing your scrubs. They've, you've now, you know, brought all of that home to them. So that is why they're recommending extending the length of the jacket or the lab coat masks. I mean, we've heard, I can't, I mean, all of us have heard so much about masks, right? And so let's just kind of go over this. A lot of this will be review for you, but I will tell you a couple of caveats with this whole and 95 and above masks. So we have our level one, two, and three. Those are our surgical masks, right?

And those are ideal for, you know, spray splatter, some aerosols, but not a lot. Okay. Doesn't have a really good seal. That's why there's this hole in 95 and above when we get to the N 95 and above respirator masks these are indicated for treating patients with airborne diseases. And because COVID-19, we have asymptomatic patients, that's a lot of the reason why they decided to transition to this N 95 and above a recommendation, and you know, a guideline interim guideline for now, if you are going to be wearing an N 95 and above you are, when you a respirator mask, you were supposed to have a medical evaluation to wear it. And you were supposed to have an initial fit test and then an annual fit test. Okay? That's every 12 months you have it. Now, OSHA came out and said, we're going to forgo the annual fit test.

They never said anything about the medical evaluation or the initial fit test. So if you are requiring your team members to wear and 95 and above masks, they're supposed to have a medical evaluation and an initial fit test. Now, the reason why everyone gets to have a medical evaluation for those who have not worn the respirator masks, or for those who haven't don't know, you might be experiencing a lot of fatigue lately. You might be experiencing headaches. You might be experiencing dizziness. That is because when you wear respirator masks, your lungs work a lot harder. And so you're not used to having to breathe harder and like to get just a little, the normal amount of air. Okay? So that's why you need to have a medical evaluation, because let's say you're a person who has chronic asthma. You might not be medically released to wear a respirator mask.

That is why, in my opinion, I believe that's why the CDC gave the alternate PPE recommendation, which is a level three mask with a chin length, face shield and protective eyewear, because not everybody can wear respirator masks. It's a Contra indicated for their, their medical history. Okay. So any type of chronic, upper respiratory disease, you probably won't be released to wear one. The other thing is the reason why you want to you're supposed to have a fit test is when you have the fit test for those who have, who have not had one, you have to put a hood on, you have to do exercises. You have to read a paragraph, you have to move around with this mask on so that we know that the seal is right. And also, so we know that you're not going to pass out because they're very hot and you don't breathe as much.

So that's it, you know, in a nutshell with the N 95 and above masks, if you are someone who likes to wear facial hair OSHA is saying no more than one day beard growth, because you're not going to have the right seal. That's why the military, you have to be clean shaven. You can't have a beard because if they ever have to put respirator masks on, they have to have a good seal. So that's the reason behind the beer growth. The other thing is, if you like to wear makeup, face makeup, or face lotions and things, because these masks don't have a lot of breathability. There's a lot of condensation that starts to happen. And it's very hot when wearing these masks. Plus we have, some of us are wearing surgical caps. We're wearing, we're wearing a surgical mask over top of the N 95.

We've got gowns on. We've got, I mean, like it's hot. So we start to sweat. And then the emollients in the face makeup or the face lotions what they do is they affect the seal of the N 95 masks. So I know some of you might be upset that you can't wear face makeup, but it is contraindicated for wearing any type of mask. You should not be wearing like face makeup, a lot of foundation or face lotions and stuff like that. Okay. the next area of PPE is your protective eyewear. This has not changed. We have to have protective eyewear. It has to have a side shields in the past you could do like a face shield combo kind of deal. But because of COVID-19, they are recommending that you have a chin length, face shield, your protective eyewear, and then your N 95 and above mask.

If you are not medically released to wear that, or you don't have enough, then you can wear your level three surgical mask. And that is okay. And that's an alternate type of PPE for you during this time. Kay. And gloves. So they are to be worn for all dental procedures replaced if compromised in any way, right. That's reviewed for us utility gloves. This is like the bane of some people's existence. They hate them in dentistry. It's very funny to me. But a lot of offices can't stand them, but the reason why OSHA CDC recommends them OSHA mandates them is they're geared to prevent percutaneous injury and chemical exposures. So some of the disinfectants that we are using to reprocess our operatories actually can cause chemical injuries because our exam gloves, the integrity of the exam glove is not protective enough for us. So you are supposed to be wearing utility gloves now, but caviat with wearing the utility gloves or not wearing the utility gloves is you can look at the manufacturer instructions for use on your disinfectant.

If your manufacturer instructions for use says exam gloves, then you are allowed to wear exam gloves. For me personally, I still wear the utility gloves because I know how exam gloves are made and they're not super strong and their integrity is very low. So I still wear them. When I, you know, when I was seeing patients, I still wear them. You can ideally get one for each clinical team member. It just makes sense because you want to make sure that they fit the reason why a lot of people don't like them is because they don't fit properly. Okay. Now, when you first get them, there's going to be a little bit of a learning curve, but it's really important for you to wear them because even if you're not wearing them to reprocess your operatory, OSHA mandates you to wear them when you're reprocessing contaminated instruments in the sterilization area.

So that's why it's ideal for everyone to have their own. And then you can get some that are autoclavable from the dental supply company. I think you can autoclave them like 20 times, something like that. Or you just disinfect them at the end of the day, and then they're fresh for the, for the next day, all PPE removed prior to leaving work area. This is nothing new. Again, this has been pre pandemic. We were always supposed to remove all of our PPE prior to leaving the work area. It's been written in the CDC for a long time. OSHA has it stated in some of their language that we should have been taking off our scrubs at the end of the day and leaving in our street clothes. But sometimes there's what we call legacy errors. And so somebody before me just did it like this and somebody before him that just did it like this and somebody before that.

And before that, and before you know it, we have a whole industry of clinicians that come and go in their scrubs, whether they're dirty or clean, they come and go. And so what we want to do is start fresh. This is an opportunity for us to really strengthen and really gear to all of these rules and regulations that have been in effect for a long time, and then adding some new ones for extra protection. And this is one of them. So make sure that everything is removed. Especially if you have a bathroom, like let's say you have a bathroom down the hall or something like that. As long as you're totally covered up, then you can take that off, go to the bathroom. But at the end of your day, you need to remove everything and just keep that as your habit, just for the rest of your career.

Basically environmental protection. This is very important has to do with reprocessing, your operatory. We want to get back to the basics. You must, must, must follow the manufacturer instructions for you. So you have to read the labels. And so there's been a lot of issue with, oh, the EPA, put out a list and as a Nancy of all these disinfectants, which is great, it's got some great information. There, okay, we're using bleeds, we're using this. We're using that. When you look at the hierarchy of disease and bacteria and all of that tuberculosis is at the top, right? Cause it's a mycobacterium very strong. Okay. And then all the way down at the bottom of that hierarchy is your Corona, human coronavirus, your HIV, your hepatitis B. What I have recommended to all of my clients is that you use a disinfectant that has a tuberculosis idol.

If you use a disinfectant with a tuberculosis Cytal and you follow the manufacturer instructions for use to fight or kill a tuber tuberculosis, then you're going to kill everything weaker than tuberculosis. And what I mean by that is let's say cat aside. So some of the cab aside wipes have two different types of instructions. They have instructions to kill HIV and hepatitis B, and then they have instructions to kill TB. I'm recommending that you follow regardless of what you're disinfecting that you use, as long as it has a TB claim, you follow the instructions for killing TB. Okay? that means on some of those disinfectants, you are going to have to have a kill time or that a contact time or a time that the surface stays wet a little longer than if you were just killing HIV. And remember, this has been going on for years, we're with, with universal precautions and now standard precautions.

We're supposed to act like everybody that walks into our practice has every single disease known to man. And so if that's the case, we should always be trying to kill tuberculosis, right? So some of the TB instructions say three minutes, five minutes for TB. And then for HIV, it's like one minute or two minutes. Okay. Go with your TV. Claims those manufacturer instructions for use. The other thing is you want to know the difference between cleaning and disinfection. So some of your wipes or your sprays or anything like that, they're going to say you do this to clean and you do this to disinfect. So you have to know if you're using wipes. Do you have a one-step? Do you have a two-step do you, if it's one step, then you can grab one wipe and do your cleaning and disinfecting. If it's two steps, you take one wipe you clean, then you discard, you grab another wipe and then you disinfect.

Okay. And so you must, must, must read the manufacturer instructions for use. And that means that you are going to have to really utilize your appointment time very efficiently. Okay. I'm not saying you have to add time onto your appointment time, because remember we were supposed to be doing this pre pandemic. I'm saying that you have to make sure that you utilize your time efficiently, or if you're under the philosophy that you know what I do want to add maybe five extra minutes, just to make sure that all of this is handled properly and correctly, and that we're compliant. We're going to add five extra minutes, then make sure if you're that employee that, that you utilize that five minutes really well and efficiently and adhere to all of the manufacturer instructions for you. So, okay. The other thing is your barriers, making sure that you barrier anything that you can not disinfect.

And what I mean by that is if it's not completely flat or round and you can completely wipe off every part of it, then you do have to barrier it. If you can wipe it off completely, then it's not necessary to barrier it. And that's according to the OSHA language. Okay. But like, let's say your air, water syringe, you can't really disinfect around those buttons. So you'd want a barrier that you can't disinfect the x-ray button or something like that. So you'd put a barrier tape around that. Okay. Any of your barriers for your technology and stuff like that, you have to make sure that you barrier those in some way, shape or form. There's been studies about mice and keyboards and huge, huge, large number of bacteria load on there. So got, gotta make sure that that's buried and changed after every patient I watched.

Station's very important OSHA mandates that you have a working eyewash station, whether it's one that looks like this in this little video, or whether it's the one single use only where it hangs on the wall on has the saline in there, or whatever, other type of liquid in there. You just have to make sure that you have one half to have a sign near it or buy it above it, but people have to have a sign. And then if you do have an eyewash station like this one here, you're going to want to make sure that you are flushing it weekly. OSHA mandates that. And they've done this for a long time, okay? This is nothing new because of the pandemic. But if you have an eyewash station like this, you have to flush it weekly. I recommend that you create a little log with a date column, and then like initial column initials, somebody can initial it pick a day of the week.

It could be a Friday. It could be a Monday, whatever you want, you go to this particular eyewash station and you turn it on and you let it run for a minute. The reason being is because if you don't, you can end up having stagnant water, that's collecting bacteria. And then when somebody actually needs to use the eyewash station, brown water is going to come out of there. I had a client that, that happened too. So just make sure you pick a day of the week and do it. It's mandated. You have to have it. And if you're an ocean specter or your dental board inspector, whoever's inspecting, you asks for it. You'll have it. And I'll talk to you about safety log templates, because I have a lot of them. There's a link I'm going to share with you guys for all types of safety logs.

And this is in there too. Okay. So just make sure that you have that. And I think that's it for Iowa. Oh, the other thing I wanted to share with you is it's a good idea to have a quick team huddle. If you do huddles in the morning, it's nice to just one morning, take a huddle right in front of your eyewash station and just show everybody in the office, how to use it. Your clinical team members might be fine. It's your admin team members that you might need to show? The reason being, you never know when an admin team member might be called on to help deliver, you know, first aid to, you know, another team member. And they might need to know how to turn on the eyewash station. So just a nice little team building, quick activity you can do, and then use of labels and color coding.

So this is pretty straightforward. OSHA requires labels on a lot of things. Containers of regulated waste refrigerators. If you have any refrigerators that have dental materials fields in it, you got to have a sign on it that says dental materials only, and no food goes in there. Okay. Containers use the store, transport ship blood that doesn't really apply to you guys. But I like to put that on there just in case sharps containers contaminated laundry bags. So if you are doing laundry at your practice, have a container that houses, the contaminated laundry. I recommend getting like a red container red trash can. That's because in our industry, red kind of denotes that this is hazardous. And then you put a sticker on there and everybody knows that any clothing items that are in this container they're contaminated. So I need to have proper PPE on my gloves when I'm dealing with the contaminated laundry.

You can have a bag. A lot of times a bag is provided by third-party. Launders. So they'll give you one already. And then any equipment that you can't decontaminate that you can't disinfect or sterilized regulated waste disposal, this is your written plan. It's gotta be in your OSHA binder, this determines what ha what waste is hazardous. And so if you live in a state like I do in Maryland our dental board has a little bit of a caveat on sometimes on what they like to see in the hazardous waste. So it might be worth maybe reaching out to the dental board, send them an email and say, Hey, what exactly needs to go in our hazardous waste? Because if you ever have an inspection, you don't want to have that as a violation. But the OSHA language says, if it's blood soaked, meaning you can squeeze it in one drop of blood comes out, then it goes into the hazardous waste.

Anything that's sharp, like sharp needles, anything that can puncture the trash is supposed to go in biohazard. Again, if you work in a state where your governing body or your inspection, you know, person, you know, the inspector wants you to have more in there, just send an email to that agency and find out what they want you to do. Okay. And then sharps and needles, you know, contaminated needles must be re recapped through mechanical device or one hand scoot method. Okay. You have to dispose of the sharps and the needles you know, immediately after use. And then you are supposed to have, OSHA is saying you're supposed to have a sharps container at eye level near the area of use. So in every single operatory where you deliver anesthesia, there should be a small, some type of container. It can be large or big.

I recommend small. And then you can put it on top of the countertop at eye level. And that's where you would dispose of the needle. The reason being is it reduces hazards when you're leaving the operatory with contaminated instruments and you're walking to the sterilization area. Now I'm going to show you guys a video, because one of the other things that OSHA mandates is that you have a sharp safety assessment on an annual basis. And what you're supposed to do is one you're supposed to go over. Like if you've had any injuries, that's the hazard. That's what we talked about earlier, the hazard certification and stuff like that, you're supposed to go over. If you've had any needle stick injuries, what, what, you know, you don't have to get into too much detail, but you can say, listen, guys, we had five needle stick injuries this year.

We need to implement something here because this is one too many. Okay. the other thing that you have to do is you have to monitor what's brand new on the market that can help you deliver anesthesia in a safer manner. And that means different types of devices recapping devices. And so what you are supposed to do is find out about those, whether you attended dental conference or something like that, I recommend if you do get a sample, if you can you bring the sample back to the practice you use the sample, or have one of your hygienists or whoever can deliver anesthesia, have them use the sample and give you feedback. And then you just write on your sharp safety assessment, your annual sharp safety assessment line for 2020. Melissa used the simple cap device. She liked it, and it really helped with being safer when delivering anesthesia.

That's it. Okay. And then you th that's it. That's all you have to do. So I'm going to show you a video of a simple cap. This is a brand new device that's on the market. It's simple as this, you show a video or you get a sample, you have somebody use the sample and then you document it. So take a look at this video of the new that they're trying to recap needles in a safe manner. It's happened in medical, on the medical side for a long time, but some of this is new to the dental field. So let's take a look real quick.

So that's a brand new item that's on the market. You guys just took a look at that. You can certainly reach out to them. I think they send samples, try a sample, and then you've completed that OSHA requirement. Okay. And you know, lunch stays in the kitchen. This is pretty straight forward, but we still do have some practices that like to eat all over the office. Hopefully with the pandemic, people are going to be more compliant with this, but basically everything stays in the kitchen. All of your food stays in the kitchen. And again, with the refrigerators, if you have dental materials in it, you shouldn't have a food in there. Now, if there's a situation where like, let's say it's just whitening material and you only have one refrigerator, then try to find a drawer or a compartment that in the refrigerator where nothing else goes in there and that's dedicated to your dental materials.

So, and what's wrong with this picture. If you guys kind of want to put in the chat, just kind of name a few things that might be wrong with this picture, we talked about masks and how we're supposed to be wearing our masks. We talked about eyewear. We talked about you know, our hygiene and I'll just kind of move through these a little bit, but these are just some of the infection control pictures that we tend to see when they're promoting infection control. And so there's always breaches in these pictures that these are marketing pictures. And so these are just some of the infection control breaches in these pictures. And you'll probably start to notice them even more. Now that you've taken a lot of CE regarding this topic now onto our next standard. So we talked about the bloodborne pathogen standard.

We're onto our hazard communication standard. This has to do with protecting employees from potentially hazardous chemicals. The United States has gone under the global system. And what that means is we have to classify how harmful chemicals and materials are in our practice. And so that's where your safety data sheets come in. You have to have those in the practice. They can be digital or paper, but those are sheets for every single chemical or material in the practice. If you're going to have them in paper, you just want to have them print it out, put them in a binder, and they're supposed to be accessible to any employee. Okay? The area that you want to pay attention to most on the safety data sheet is section four. That's the first aid section. If someone gets injured by a particular chemical or material, you go to the safety data sheet, look at section four.

It tells you what type of first aid to administer. Okay. these Piccolo grams, these are just icons that communicate to the user, how, you know, hazardous the material is. If you take anything out of its original container, for instance, if you take, like, let's say some people buy the disinfecting concentrate and they pour it into spray bottles. If the spray bottle does not have manufacturer instructions for use on it, then you have to have this sticker it's down on the right. This particular sticker has to be on that container. And then you can order those stickers from any dental supply company. Okay. So you just want to make sure that you are have those stickers on any type of, any type of secondary container containers that you're using, where you take the original contents out. And then here are your safety data sheets.

You want to make sure that if you do have them digital, I didn't finish this, but if you have them digital, you have them either downloaded to a computer where everybody has access, or you can keep them in your dental supply company account. Because now all the dental suppliers have them automatically downloaded. Whenever you purchase a product, however, all of your employees have to have access to it. So if you don't want to give your login information to them, then my suggestion is you download all of them digitally to a folder, and you keep that on a main computer for your team.

The next standard is the ionizing radiation standard. This has to do with occupational radiation exposure. Your exposure controls are going to be properly functioning equipment, your barrier wall and your lead apron. And then some of you might still have to wear a film badges. You just want to check with the, or the agency that's doing the inspection of your equipment and they will let you know how long you have to wear a film badges, because now we're kind of getting away from wearing those indefinitely. Sometimes you only have to wear them for about a year after you purchase the equipment. And then recordkeeping, if you have any type of malfunction, you do have to record this in this section, in your OSHA binder. If you had to have any of the equipment maintenance or what happened, did you have to replace it? It just has to be documented.

And then ergonomics, hazard and prevention. This has to do with work-related musculoskeletal disorders. You are supposed to do type of workplace analysis. So if you have certain employees that are constantly doing a certain type of task, like maybe they're taking out the heavy trash all the time, then you're supposed to rotate tasks like that. You don't want one person having to do one thing that could actually give them an ergonomic hazard. So rotating tasks, performing four handed dentistry, doing a lot of stretching. Maybe you treat patients standing up and then you treat patients sitting down. So you alternate, you take a walk in between patients just to kind of move around. You can do stretching, you can do desk yoga there's different neck rolls and stretches that you can do. You have to have some type of employee training. We're doing that now. There's a lot of videos on YouTube.

There's also a really great ergonomic expert. Her name is Katrina Klein and she's ergo FitLife. She will come to your office and do a whole analysis, which is really phenomenal because she looks and observes everybody. And she's she's online. It's she's on Instagram, ergo fit life Katrina, I think. But anyway, ergo, FitLife, she's really great. And then you also want to have any type of record keeping. So if you happen to have training on this, or you have somebody come in, you just keep a record of that in your OSHA binder. And then of course, you know, if you look at this picture on the left, all of us probably have had a pain, at least once in our dental careers, right? In every area, right. All of our, all over our whole body. So that is why OSHA is saying, you need to do something to kind of alleviate these or prevent these hazards. And then on the right, this is a picture of the yoga dentist. She actually has a YouTube channel. She is a dentist, and I like her because she has specific stretches for dental clinicians. So she does risk stretches, neck rolls, everything that can be done in the operatory or at the front desk area throughout the day, to make sure that you prevent any type of ergonomic hazard. Okay.

And now we're moving on to our evacuation standard, the emergency action plan area for OSHA, they mandate and say that you have to have a plan and it has to be a written plan. So if you are a practice owner on here tonight that has multiple locations, this particular area has to be customized according to the geographic location of the practice. So that OSHA binder that's in practice a has to be customized to practice a and then your other location, the action plan has to be customized to location B. You have to have an evacuation map in a visible location. They don't say where, but the languages in a visible location, it does not have to be professionally done. It could be nicely and neatly written out, but it has to be a whole evacuation map plan of how you get out of your space and where do you go?

Okay. the written plan, like I just said, has to be customized evacuation procedures are included in that written plan. And then I recommend a code word. Like for instance, if you have people that come into your facility and they're not patients, they're not supposed to be, they're not supposed to be there. You want to have some type of plan in place. How does your front desk, how does your reception area team members handle that? And what do they do? Okay. Maybe a code word, you know, they can call to the back, you know, elephant is in the room or some thing I don't know, but that way, it just alerts everybody to say, Hey, there's something going on at the front desk. Remember we talked about situation awareness. And so that's very important for everybody to know what's going on for the safety of the practice and then stay calm and don't panic.

So as an employer, it's your job to be the leader. A lot of times the employer during an emergency ends up leading the ship, right? You want to be clear and concise with your communication designate and evacuation assembly points. So if you do have to evacuate, where do we go? Do we meet at the back of the parking lot? Do we meet down the street at Starbucks? Like, well, do we meet at the mailbox? Like where do we go? Right? And then once that whole emergency is over, maybe the next day or a couple of days, give everybody some time to digest it. You have a debriefing huddle and you talk about the incident and what happened and where were we strong and where were we weak and how can we strengthen those weakened areas so that this doesn't happen again? Or if it does happen again, how can we do a little bit better job?

Okay. And then as employees, you want to make sure it, especially if you're not in a leadership position that you know, the emergency evacuation plan and then any tasks that you are given, make sure that you carry them out calmly and professionally. And here we are to the Corona virus section. I think that this is what everybody really was looking for tonight. This is coming directly from that original preparing the workplace during COVID-19 document that OSHA put out that many of you probably viewed it says that you want to develop an infectious disease, preparedness and response plan. So what you want to do, you should write down all of the new protocols that you have in place. It's just like a one or two sheet document you write it down or type it up. And then you're going to put that in your OSHA binder, that's going to be your COVID-19 infectious disease, preparedness and response plan.

Okay. That means if you're having patients waiting in the car, if they're performing hand hygiene, when they come in step by step by step, okay. And then you put it in your OSHA binder and that's where it stays. It prepared to implement basic infection prevention measures. All this means is that you should be following everything that was in place before COVID-19. If you weren't or you were a little weak, or you were a little lax, now's the time to tighten up and make sure that all of these protocols are in place and that they're being implemented every single patient every single day. Okay. Develop policies and procedures for prompt identification and isolation of sick people. So you're supposed to be doing that with your telephone triage when you call to confirm your appointments. So you can't no more during this time, you can't text your patients and confirm their appointments.

You have to be doing a telephone triage. Okay. And then when they arrive, you're supposed to do another triage and ask them all of the questions and take their temperature. If anybody's sick, you dismiss them right away. If your team members are arriving at the beginning of their shift, they go through the COVID-19 questions and report any symptoms. And then they also get their temperature taken. If they're sick, they get dismissed. That is what your policy and procedure is to isolate sick people, right? And identify them, implement workplace controls. This has not changed since before, you know, this is the same before the pandemic engineering controls. Those are your devices. That's what we talked about. We talked about if you're using the one hand scoot method, but it's not working and you're getting needle sticks. You have to get a device, the N 95 mask.

That's an engineering control because it's a device external high-speed evacuation device. Okay. Administrative controls. You're going to put up the sneeze guards for the admin team. You're going to maybe email receipts instead of giving paper receipts, you're going to have your administrative team trained to disinfect the reception area and the doorknobs and things like that. Safe work practices. Those are making sure that your team gets trained. These are their habits, making sure you're following up with them every day at the end of the day, Hey, you know, observing them, are they doing all of the protocols after every patient? Whenever you think about it, get up, walk around your practice. If your hygienist or your assistant is seeing a patient, it's not your time to see the patient yet walk around and make sure that they're performing safe work practices. And then your PPE.

There's a great video. OSHA has a great video for wearing N 95 masks. If you want to do like extended use versus reuse that there's a difference. Reuse means you're going to take it off, you know between each patient, you're not going to contaminate it, but you're going to take it off. Between each patient extended use is you're going to put it on before the first patient. You're going to wear your surgical mask over top of it. You're going to wear it and see all your morning patients. And then when you get to lunchtime, you're going to take it off and then you're going to store it. And then after lunch, you're going to come back and put it on and wear it for the afternoon. Patients that's extended use. And you are allowed to do that because we are in a PPE shortage following existing OSHA standards.

I talked about that. That's what we need to be doing. I mean, nothing has changed with any of the other mandates that have been in place, like I said, for years. Okay. And then clarify worker risk exposure. So what I mean by that is your engineering controls. So some of your admin team has a little bit less of a risk than let's say the dental assistant or the dental hygienist or the dentist, because they are closer to the aerosols and the aerosol, the aerosol producing procedures, they're actually performing them, or they're assisting you when you're performing them. They have much higher risk than your admin team. So there's a couple of caveats with that. You need to clarify that if you're short on PPE, then your admin team is going to wear and CDC recommends this and they say, it's fine. The admin team is going to wear cloth masks.

Like they would, if they were going to the store or they're going into, you know, the grocery store, wherever they're going, they can wear the cloth masks. You are going to reserve the PPE for your clinical team members because they have a higher risk. Okay. So hopefully that makes sense. Now, as of last week, this is what came out, OSHA I'm on their newsletter or their alert newsletter. And this came out as an OSHA alert and it was specific guidance for dental practitioners. And if you read over here onto the, on the right, this is basically what it says, you know, encouraging workers to stay home maximizing use of telemedicine provide adequate ventilation and air flow frequently clean and disinfect surfaces with hospital grade, EPA approved cleaning chemicals, okay. Minimize the number of staff present. So there are some offices that have a sterilization tech that goes around and might restock rooms while people are seeing patients.

We're not going to do that during this time, because we want to minimize the amount of staff team members or staff that's in the room when the aerosol producing procedure is happening. Okay. A admin team is going to kind of stay out of that area unless it's absolutely necessary. Okay. That's what they mean by that. Provide appropriate PPE. We talked about that and then encourage workers to report any safety and health concerns. If you have anybody that's experiencing headaches or dizziness or anything like that, nausea from wearing the N 95 masks, they are to dismiss themselves immediately and go remove the PPE, remove the mask because you don't want them passing out. You don't want them harming themselves from trying to protect themselves, allow them to remove themselves so that they can get themselves together and actually get adequate oxygen into their body. Okay?

Cause we don't need a, an emergency that way. These are your HR considerations during COVID-19. If you mandate and 95 masks, then it puts you under the entire rule. And that's what OSHA says. That means you have to do the medical evaluation. You have to do the fit test. You have to do annual. If it, if you know, if, if they make you do that voluntary and 95 masks that what I mean by that is you are allowed to present it to your, to your team in a manner that it's a voluntary. However, you do leave yourself open for risk management and liability. If you go that route. So it's a slippery slope, it's unfortunate, but they have these really for big, large medical facilities, however dentistry and dental practice owners, we still have to adhere to this. So I can't really give you any more information on that.

I've contacted OSHA about this, and that's basically what they told me. So that's what that is. Annual fit test temporarily suspended. We talked about that OSHA did submit a temporary infectious disease standard to Congress I'm on an alert for that. It was submitted back, like when all of this started it's been submitted, I think, to both the house and the Senate. And I think that, I think the Senate has to look at it or something, but right now that's where it is. So I, we don't know if there's going to be an actual infectious disease standard, like the bloodborne pathogen standard, but we will soon find out I'm sure. OSHA can use professional industry info to uphold violations. That just means that if you try to say during an inspection, well, I didn't know. And they know that you're an ADA member they're going to say, well, we know that the ADA communicated to all their members, so you should have known that kind of deal.

And then they are going to observe good faith efforts. So all of the local level OSHA offices I've been told by the federal level to observe good faith efforts for any practice owners. Okay. And so try to do your best adhere to the CDC recommendations and what your governor is mandating like in some states, the governor's only adopted part of the recommendations. So you need to know what recommendations from the CDC that your governor mandated in my state, in Maryland, our governor mandated or adopted only certain CDC recommendations because that's what he wanted to do. And so we have to go according to that. So find out what your state is doing. So that way, if you get an ocean inspection, the OSHA inspector can observe your good faith efforts. And then lastly, do a PPE supply review, find out what you have.

The CDC has a burn rate calculator it's a pre-filled Excel spreadsheet. It's right. You can Google it. CDC burnt PPE burn rate calculator. Okay. you plug in type in all of your PPE and it'll give you the amount of time that it will last. So it's a pretty cool tool again, that's CDC burn rate calculator, helpful, helpful tool. It'll let you know how long your PPE supplies gonna last. Okay. And these are just your next steps. And just some suggestions, you know, that you should do regarding OSHA and safety in the practice. So your team huddle monitoring what's happening, you know ma you know, appoint a safety officer. That's important, proper record keeping. I talked about that, making sure you're organized and then periodic assessments and your annual training.

And then lastly, guys, thanks so much. Who's lost her audio, India. We lost your audio, India. Can you hear me? Okay. In front assessments that I talked about tonight, it's all free. Totally downloadable. And take a look. Okay. I think we done Lisa. You are absolutely like, did you breathe during that presentation? Okay. I think I need to take off like a drink. Let me take a drink really quick, because honestly here I'll come back on the screen here. Yeah. Whoa button. You guys got me sweating in here. I'm really working. I'm trying to make sure you guys get all this for me.

I mean, seriously, it was like, I know it's a lot, it's a lot packed. It was packed, jam packed. Beautiful, beautiful, wonderful presents. Amazing. Great, good. Yeah. I mean like a ton of questions I've feel that a little bit, some tech problems and things like that. So those aren't big deal we eat. In the end, your video went out for me a little bit. I don't know if everybody else heard, but just tell us again what you have, where we can reach you if we need to reach you. I know that you do consulting in private offices that you have private clients for compliance and things like that. And I'd like everybody to know that you that you provide that resource. So if you want to tell us again, what you, what you are about when you're not talking to us, that would be great.

Sure. Yes. So I'm an independent compliance consultant for learn to prevent, you can visit, learn to prevent.com that's L E R N the number two prevent.com. You can email at info at learn to prevent what we do is we provide like mock inspections. We do a CE compliance training in office. We do coaching on dental unit waterline programs. We have access to different resources for you to get special pricing for certain things that have to do with compliance. I do a lot of consulting with you know, a lot of working one-on-one with dental practice owners, making sure that we do their OSHA binder reviews. Gosh it's kind of customized really because our industry is unique. And so we do a lot of things. We do it virtually, or we do it in person. It just depends. You know, so I've worked with people from all over the country.

If I'm not there in person, we do it virtually and you know, everything you get, I hold your hand the whole way, because sometimes this can be very overwhelming and it's a lot of information, but we do our best and then we have online e-learning we just launched for those on the line, this might be helpful to practice owners. We just launched an OSHA training for new hires. So you don't have to give the training yourself. You can visit learn to prevent.com click on e-learning and there's an OSHA for new hires. You have them watch that it comes with a 15 minute call with me and you just schedule that. And then if there's any questions with that new hire, I'll go through that with them. They get a certificate of completion and you put it in their employee medical record yeah.

Employee health records. So that's what I do. That's what we do over here. It's all about safety. Yeah. Well, I mean, it's amazing. Well, it's very calm. It's not cut and dry. I mean, it is, it is it's unto itself. It's it is an amazing volume of information. And particularly now I think when our, when our senses are so we're so hypersensitive, sensitive to the issue, we want to make sure we're doing everything right for everybody's safety. Yeah. And I think, you know, we're all taking a certain pride in it. There's a little bit of fear, but I think, you know, really, I think action helps us accomplish what we're trying to accomplish. So if you start with OSHA, I think you're good. Like if you, you know, that you're doing at least the absolute, you know, best. Yeah, exactly. Yeah. And if you guys have questions or anything and we don't get to them tonight, you can certainly we're all over Facebook and Instagram it's at learn to prevent, so you can certainly message us and we'll, we'll get all that answered for you.

Fantastic. And I'm happy to say that India and I have talked about her coming back to do a two part series we asked that's. I love that chorus too. It's all right. It's totally, it's all good. It's all good information. So before we go to the Q and a the official Q and a, what I'd like to do is just tell you that tomorrow night we have one more webinar this week with Dr. Pamela Ray, that you can sign up for. It is about periodontal coding. It is actually a webinar that she was planning on giving to just a study club that kind of grew and got a little out of control, which is what's been happening online, but she is more than happy to have everybody participate and, and sign up for that. And then next week we are having somebody talk about a fellow by the name of why am I blanking his name?

I should have written it down because, you know, it's like, I've COVID brain. Right. right. It's like Hm. All right, it's fine. I'll, I'll talk more about him tomorrow night, but anyway he's giving a webinar on your hygiene and how to get your hygiene relaunched, which your hygiene practices relaunched, which has really, really been an issue. I know for a lot of my friends that are practicing now because you know, there was such a delay and they're trying to make it up. And, but, you know, there's a lot of questions about, do you clean the rooms now? Do you clean, you know, how long does it take, et cetera, et cetera. So anyways, so he's, he's going to be amazing. It's to teach us a protocol for that. I also want to give a shout out again to Dr.

Schreiber from New Jersey, hope you're staying safe. And I went through the little I don't usually look very closely to all this, but I was trying to just skim through this. And also we have some regulars and I just want to how much that means to me Dr. Tillman and Dr. Hay deed for attending so many of the webinars over the past six years. Thank you very much for being so supportive of the DC Dental webinar series. You you really are fantastic fans. And I cannot tell you how much I appreciate that. We've become very popular recently. I have to admit that, but in the old days when it was just, you know, a couple of us, you know, you guys were there for us. So thank you. And again, thank you to DC Dental for always being there, sponsoring us and for having an 95 K in 95 masks available and other things, you know, all kinds of other things that they have been trying to source for us.

Okay. Let's get to the questions. Okay. Where do we get the fit test for clinical employees? The mask fit test that is the million dollar question. Unfortunately, they're mostly sold out and there's a lot of price gouging happening. You can try your local fire department. You can try your local hospital. They tend to be giving them for free. I believe I just found out that some of the fire departments are giving them for free because they're some of these companies that sell the fit tests, you have to be like a very large organization, or like a nonprofit, like a fire department in order to even purchase them. So the smaller business person is not even able to purchase. So check there. You can try dental supply companies if the hospital and the fire departments are not available. I know Benco had some that they were selling Amazon.

You can't even get them to like, I don't know, August or something like that. So try those areas those, those organizations first. And then other than that, I don't know what to say, unfortunately. Yeah. The problem is we know what to do for the most part. We just can't access it. And that's, and you know, there's a whole lot of YouTube videos on how to, how to, how to fit a mask, you know, whether or not they're they're actually working. I treated, especially at the time and I was concerned, cause I could smell her perfume so intensely. And I asked and did everything. I said, she just said too much perfume on. I think I was going to smell it through. And I had a shield. Everything still got that's from the sniff test, but I actually was kind of happy. I know that sudden loss of smell is a sign of COVID-19. So I guess I did. Right. Yeah. That's great.

Prior to COVID-19 I've seen this water used for two days in the ultrasonic, is that right? No, no, no, no. You have to drain that solution daily. You have to start with fresh solution every day. You and that's before COVID-19 nothing to do with COVID-19. Should each practice have an OSHA officer other than the practice owner? I'm sure. Yeah. It's good to have more than one person, because remember, as the practice owner, you can't walk around with the OSHA inspector. So you want to have someone that's competent to be able to answer questions and can really explain, you know, all of your protocols in the practice. Okay. does this webinar satisfy OSHA requirements? Yes, it does. Yeah. Some of the states have to have this for license renewal, and then it does. And then if you, as long as it's the w well, it was an hour, I don't know however many CES you're giving for it, but as long as it meets the state requirement, if you you're using it for your license renewal, and then if you had your whole team on here, you're going to visit that link and you're going to download the OSHA training log.

It's the very first free download that you can get. And after you create the account and go in and you'll just fill all that out and then you'll keep that in your OSHA training log. Fantastic. is K 95, okay. For aerosol procedures or do, does it need to be N 95? No. Okay. And 95 is just the Chinese version. The version that comes from China and fun fact, they actually test theirs on humans before they sell them. We don't here in America. So that's a fun fact. So that's why if you have K and 95, you don't need to do the fit testing. Okay. Got it. CDC and OSHA do not seem to have the same message with PPA. CDC says okay. To use surgical masks with face shield, but OSHA states only in 95 pertaining to COVID-19. Can you comment about that?

Well, OSHA and CDC have two different missions, so that's where you're going to see different information. HSA deals with employee safety, CDC deals with patient safety, so completely different missions. OSHA did say that if there's a shortage, then you wear a level three. You don't have to, where if you can't get an N 95 mask, then you wear a level three with a chin length, face shield, and the protective eyewear. That's the same thing that the CDC says. So I'm not sure what else might be different, but if you are seeing some differences, it could also be that some of the PPE requirements on OSHA side come from the bloodborne pathogen standard, which has to deal with diseases, being transmitted through bloodborne routes. This COVID-19 is airborne and it's droplets. So it's a little bit different. So you might see some differences there.

Now there are airborne precautions, but that's more like in a hospital setting or something like that, you know, negative pressure room and stuff. So that's why you might see the difference there. Okay. But let me just say this, you have to follow whatever your governor is saying for you to do. He dictates, she dictates it to the health state department that the state health department and the health department dictate it to your dental boards. And then the dental boards communicate it to everybody. So if they're telling you, you have to follow the CDC and you have to do both. Okay. have you seen the world health organization statement? Think of it as a question today. I'm gonna say that you need to follow what your, your governor and yeah. You're a, whatever your dental board is communicated to you. If they have not communicated to you, then you need to go back to the executive order that your state government has put out and I'll get it.

I agree. I read that today and what it was it was vague, but anyway, that's, I'm just going to leave it there. Okay. do we need to stamp date, everything summary, honestly, what I've learned through all this, that people don't know what we do. Do we need to stamp? Yes. So that is a CDC recommendation. You said stamp, is that what you said, date stamp it, everything that you sterilize. Yes. So you have to have the date, you have to have your initials and you have to have this falls under CDC recommendations to guidelines. The date, your initials, whoever's doing the sterilizing. Or yeah, and the cycle or load number, and then the actual sterilizer, if you have multiple units. So if you have a sterilizer and a Statom, it's going to be a B or one two, if you have two sterilizers, it's one, two AB whatever that has to go in there.

The reason why is because that allows you to track. If you have an infection control, breach, a malfunctioning, a sterilizer, or Statom, you can kind of trace back to what items didn't get sterilized, and you go and you collect all of those off of the floor and those get re-sterilized in a properly functioning sterilizer. Fantastic. Okay. Regarding an OSHA inspection, does the employer have to let the inspector into the clinical areas while there are patients being treated, or can the employer schedule an appointment for the OSHA inspector return at an opportune time you're allowed to do that? It's not recommended in among the compliance specialists. We don't recommend that we wreck. I mean, you can, you're absolutely within your rights, like for instance, like, let's say they come in the practice owner, isn't there, then they do have to be rescheduled to come back when the practice owner is there.

We don't recommend that because it sends a little bit of a message to them. Like they feel like you're trying to hide something. So you can certainly ask them to wait until patients are, are, you know, dismissed. Or maybe you can say, is there any wait and come back? Like at three o'clock we're totally, you know, you just want to be very gracious with them and say, totally okay with you, but we just have to finish this procedure. And can you come in? You know but don't, you know, be careful with that only use COVID as an excuse. Sorry, we can't have you in the army. Yeah. Yeah. Well, they, they did put out, they did put out OSHA did put out some information that they are going to be paying attention to high high risk workplaces and dentistry is on that list. So be careful, make sure, yeah, we haven't really gotten a lot of inspections in dentistry, like on a regular basis, but they're paying attention to us, Rodney Dangerfield of the healthcare profession. I mean really of healthcare professions. Like we don't get PPA. Okay.

Hopefully neither charge and we're not going to be looked at like that anymore. Right. Exactly. Exactly. And we're all trying. I mean, I have to tell you from the bottom of my heart, you know, everybody is trying so hard to do the right thing and we just honestly just need to know what that is. And sometimes the answer is, I mean, it's really, it's not okay. The CDC is not OSHA since the CDC is not OSHA or the CDC posters required. And do they have to be requested? Did you hear me okay now I hear you. Okay. Can you repeat that question? Sure, sure, sure. If the CDC is not OSHA or the CDC posters required and will they go out automatically or do you have to request them from OSHA, the posters from CDC or the posters from OSHA?

So CDC posters, you can go right online. It's print CDC, print resources, just Google that. And it's the very first link you click on it and you go to healthcare facilities, they are recommending that you post certain posters for the health care facilities. The reason why I'm saying you should post them is because if your governor told you to follow the CDC guidelines, then CDC is saying posts these couple of posters. So that's why you need to post them. OSHA has mandated posters. Department of labor has mandated posters that you can the OSHA poster, it's like a big it's a free poster. And then you have a department of labor poster. You can get it. You just Google department of labor posters. You choose your state and you buy them from like a third-party company, the OSHA poster, you just Google OSHA workplace poster and it'll come up and you just order it it's free. And they'll send it to you. The department of labor, Corona virus act one that F F C R a, you just Google F F C R a poster. That'll come up. It's a P the VF. You just print it and post it. That's department of labor. You have to post that because department of labor is a legal entity. Yes.

After how many years should you update your binder? So I looked at a binder in the last couple of days from like 1987. So so, and then CDC guidelines for dental settings came out in 2003. So if you have a binder from the eighties or the nineties, like pre 2003, you need to update it. The other thing I would say, it's not that you necessarily have to update it, but you have to make sure that you have current information in there. So if it's like 15 years old and things have changed, then you have to update it. It's not that you have to update it every single year, but you do have to update it if things have changed. Okay. Can the employee work the 15 days while waiting the 15 days for the letter following the needle stick?

Yeah. I mean, most of the time, the medical care follow-up will say to you that the provider will say, you can ask them, can I go to work? And they'll say, yeah, we'll write you a note and they'll just let you go back to work. Or they'll say, no, you need to wait until Monday or something. So yeah. They'll let you know, like right then and there, when you can go back to work and they'll write you a note for that. Yeah. Is it required or recommended by the CDC to get have the Hep B vaccinated OSHA mandates it, there is no, this has nothing to do with the CDC. Well, I'm sorry. CDC recommends, but OSHA mandates. That's the one that you have to have. If you're going to treat patients and that's the immunization that employers are required to pay for now, the caveat here is let's say you work in a health a hospital setting in a dental clinic, like for the VA hospital or the prison system that employer might require you to get a flu shot. If your employer requires it, then in order to work there, then you have to do that. If your employer's not requiring anything, then OSHA says, okay, the only thing you have to have is the hepatitis B.

Got it. Okay. there is a request here for somebody, for you to do training in their office. How do they reach you in info@learnthenumbertwoprevent.com info@learntoprevent.com. Just email me. Good. Okay. Good. How do you take the test for the CEU CEU? Continuing education credits, you know, they want to know how to take the test that was today. It's going to pop up at the end of the, of the, you just do it. Yeah. Right. As soon as I turn it off, I just did my OSHA thing in my office. And I don't know what it's like. When you tell your place to take off artificial nails, that's a really good question. Know, you can put it in as part of your employee handbook, right? That's can be a requirement. There's some, there's some facilities like, like hospital settings and different stuff. That's part of their, like, you can't do that.

So this is the time. If you are going to do anything like that, now is the time to recreate your employee handbook. This is like the clean slate. Start over rehire, everyone get all of your HR stuff in place. And there's an awesome resource called stream dental, HR stream, like a water stream, dental, HR, check them out. They're awesome. They will walk you through the whole process. They're phenomenal. And like, this is the time to do all of that, but you have to have it written and you have to communicate it to your team. You can't just single out whoever. Cause that's not going to jive in H in the HR world. If it's not written, it never happened.

Do front desk staff need to wear need to be vaccinated for hepatitis B. No, only if they have a dual role as a clinical team member. Okay. Are goggles required or recommended to be worn when wearing face shields? Yeah. You have to have protective eyewear on, in addition to the face shield. Yes. That's. OSHA is saying that that's the alternate PPE. Okay. For now. Okay. our employers are sponsorable for laundering, scrub tops and bottoms. No, just the outermost layer. Got it. Okay. Is wearing, okay. Are waist jackets, permissible or only long gowns? No. I mean, you can wear a waist length jacket, but the CDC is recommending longer jackets because of all of the aerosols and splatter and everything. Now with the COVID 19, I mean, you can still wear the waistline jacket, but they're recommending you extend it to the knees or longer.

Would you recommend using Lysol laundry sanitizer for laundering? No bleach color, safe, bleach color, safe bleach. Okay. And hot water. That's it. Do you have to change gowns after every patient or only once a day or when it is soiled the experiment? I guess. So we're in the interim. So the interim says, CDC says after every aerosol generating procedure, so gotta change them after every patient OSHA says when visibly soiled, but that was pre pandemic. So right now it's every patient or every patient or when it's visibly soiled. So you might still be, you know, right, right. Now there's a PPE shortage. So sometimes, you know, you have to think about that and you have to determine how you're going to make your PPE last. I mean, you're doing the best that you can in a PPE shortage. That is really only thing I can say with that very much.

So I bought some on Amazon, these disposable rain slickers with hoods. So hot. I mean, I'm in new Orleans. They're so hot. I can't wear them. I mean, they're very protective. They're passing out. I have them at least as alternatives if we run out of the gowns, but I can't do surgery. And it's, you know, it's got a, they're great for the rain, but they're not. So yeah. You just say this and I, I can't remember if I, I can't remember if I've mentioned this on the hierarchy of controls, disinfection and sterilization way higher than PPE. So we're putting a ton of emphasis on the PPE. If you disinfect and sterilize properly, you're doing a lot more to eliminate disease than wearing PPE. You can wear an N 95 all day long. If you don't sterilize and disinfect properly, or you don't wash your hands and perform proper hand hygiene, you are going to get some type of disease.

So exactly. We have to make sure that we put it in perspective and that just goes back to your microbiology days and all of that. Like we have to just kind of go back to dental school and dental hygiene, school days and dental assisting days when we really learned the order of everything. Right. Also, I think it's really important not to get your mask wet besides yeah. Wash masks. We're not gonna spray them with hand sanitizer. We just did a whole thing. Like I think a couple, like last week on our learn to prevent on Instagram, we listed everything that we've gotten questions about. People are using toaster ovens. People are washing them and hanging them on clothes lines. You can't do that. It's a host of stuff that's happening. And even the mask manufacturers have said, if you wash them and wet them, you decrease the effectiveness every time by 20, like it's like 21%.

So yeah, you don't want to do that from what I've read the N 95 mass and the K in 95 masks have a filter inside that has an electrostatic charge on it. So exactly the charge, which is actually the thing that is preventing exactly the viral particles. So I mean that long what if you have oily skin or you're sweating, those are also questions everybody's going to be sweating. You just have to make sure that if you, you can feel, if it's like moving and it's not working right, then you're going to have to like, excuse yourself, perform hand hygiene take off the surgical mask perform hand hygiene again, you got to do it. If you don't want to contaminate the mask and then you need to readjust and make sure that it's fitting properly and then you're going to put everything back on. Yeah. Yeah. I it's like tough because they're very hot. It's really unbelievable. Ton of people saying great lecture. I dunno why they're saying that really though. Right.

And it's like great lectures. Okay. Do you need a medical evaluation of using kn 95 masks for team members? I think no. No, no. Is there a list of OSHA requirements for each state or is it national? So if there's a federal level, there's a federal level. So the bloodborne pathogen standard federal level, the record keeping federal level, the only thing at your level, you'll just want to check your state plan to see if they make you do anything. Like in addition, like in the state of Virginia and a couple of other states, you have to list some extra things about different roles in the practice. And that's in like their OSHA binders that like other states like Maryland, you don't have to do that. And Delaware just different couple of different states. You don't have to do that. So yeah, it's federal, but your state in particular might have you do a couple extra things. You just go to osha.gov and look up the state OSHA plans and look for your state and you can contact them and they'll let you know. Got it. Okay. so there's some questions about garb that I believe we've answered. The there's a question about if a patient is a COVID healthcare worker, should you postpone their treatment?

There's well, it's, it's C cause that's a slippery slope because you're not supposed to discriminate because you're supposed to treat everybody the same. Like everybody's got every disease known to man. It's like, what happened during HIV? If you knew somebody who had HIV, you couldn't like treat them differently or where different PPE, because they have HIV. That's a tough one. You might want to have a conversation with maybe your malpractice insurance or your malpractice attorney and find out what your kind of rights are with that regarding malpractice. A lot of those health, frontline healthcare workers understand what's going on. And a lot of them have postponed a lot of this type of procedures because they know what's going on. So I don't know that you're going to get a lot of them, but if you do, you have to go through and ask them the questions.

And one of the questions is, have you been in contact with anybody with COVID-19? And if they say yes, then you have to reschedule them. So that kind of helps you with that outside of that, that's really nothing you can do. Well there, you know, I guess the other option is to have them tested before you treat them. Yeah. Yeah. They just have to show you. Yeah, yeah, yeah. Yeah. So I'm going to limit to one more question. I'm going to ask one more question and then, because it is getting late and I have to tell you there's a list of them, but to everybody, sorry, if we couldn't get to your question, but India provides such amazing resources that I think that she, she and her team will probably, you know, like she says, she's got all this information. So go to our website, download her, her info, you know, all these, these amazing resources that she has read through it. And if you still can't, you know, if you, if you don't get the answer to your question, I'm sure she'll be happy to, you know, to answer it for you. Okay. So I like this question because this was in the CDC guidelines and I, I I don't agree with the CDC guidelines about it for, and I have a reason. So, so this will be interesting. Okay. Should we wait 15 minutes after a patient to clear the room of Eris of aerosols before bringing the next patient in?

So the CDC, yeah. I know what the CDC says about this. Well there is no substantial medical evidence or scientific studies done in a dental practice. The studies that they have are in medical ORs, and we're not like cutting people open and stuff like that, basically. Right. So the 15 minute rule, a lot of where that was like taken from was the medical industry is where they took this from. You have to make a conscious decision. You have to look at all of the evidence. You have to look at all of your protocols that are in place to determine if you want to let the room rest for a while or not. Okay. I'm going to say that I think 15 minutes is a long time. However, if 15 minutes is good and that what you want to do, that's fine.

There are other protocols that have been recommended to kind of avoid the whole 15 minutes of rest. Like, you know, doing the high-speed evacuation, the external high-speed evacuation, the HEPA filter, you know, filtration, you know units and stuff like that. So if you're, now I will say, if you're gonna use that fogger, there's like this fogger that a lot of people are going to be using in the practice, then you have to fall. If you're gonna use that farther, then you gotta follow the manufacturer's instructions for use for how long you can have anybody in the room. If you're not gonna use that fogger, then the more important thing is to make sure that you're doing some type of aerosol reduction and your disinfection. And you know, that then, you know, there's just, no, there's no studies yet, like in a dental practice. Exactly. I mean, that's the issue I have sometimes with the CDC, a lot of their recommendations for us come from the medical industry.

Totally different. Yeah. It's just like their, their stat for needle stick injuries. They they say that our needle stick injuries are, they just estimate it. So, you know, so, yeah. So that's just my opinion. I want to put that on record. That's my opinion. I had a very similar question from somebody. It was a little bit different, but as a lot of you know, that I've been doing a lot of research about the cold fogging stuff with the hypochlorous acid. And so a question came up about that because it was a hygienist wanted to know, you know, does she have to wait? It was really more do I wait 15 minutes before I clean the room? So I was like, well, you've just been in the room where the aerosols created with all this protective gear. Why are you waiting 15 minutes?

And she said, well, because the droplets, you know, they say that the droplets fall. So I spent three hours trying to find information on it. And again, it's all extrapolated from medicine. But what I did find out was that the droplets fall, but those are the larger droplets. The smaller aerosol particles remain in the air after 15 minutes, like three hours is something called droplet nuclei or something like that that still have little viral particles in the air conditioning. So that's one of the reasons that a lot of people are interested in cold because after they wipe the snow down of everything that's dropped, they then want to try to do to reduce the viral load in the air. So I mean, it, it is, it can be very confusing because we do depend on the CDC for guidelines, but they you're right.

They, they don't, they're not looking at dental practices and they really can't. There's no precedent yet. We're kind of gating all that science right now. And a lot of what we're doing just anecdotal, it's just based on the best guests we have right now at the time, like you say, reducing, it is probably better than anything else other than, you know, nothing and detecting protecting yourself. So I don't know that there's definite answer even to the question. Yeah. There's really not. I mean, honestly, there's really not. And then it goes back to, like, I was talking about personal health, that's your first barrier. Like all of this has to be done as a whole in order to prevent hazard and dizzy. So you have to do all of these things together. Yeah. Right. Exactly. And you have to take it all into consideration. I mean, I don't think waiting 15 minutes is really going to change anything.

That's all. I just don't think that there's going to be no, not if it stays in the air for three hours. Right. Or, you know, and you know why they say three hours, I just read because they stopped testing after three hours. Exactly. Yeah. So we don't really know. Right. Yeah. So this has been amazing. I cannot wait for you to come back and do the infection control one really. I mean, I'm going to talk to you really soon. I mean the next day or so I'm going to send any, and we'll get that scheduled because I know people will absolutely just be so excited to, you know, to cure you on that. I mean, this was, I don't know how you have all that up in your head, honestly, don't it was just a massive amount of information. As a matter of fact, I had to do some clerical stuff, you know, like handle some things, but I can go back and watch your tape. Okay. As soon as it's available so that I can make sure that everything right, you're going to have to do that. I want to thank everybody for attending your time and devotion so much and be safe, everybody. And we look forward to seeing the release soon. So good night. Bye-Bye bye. The quiz will pop up now. Okay. When I turn it off, I.