The Compliance Divas Podcast
Our podcast covers current topics such as infection prevention and control, OSHA and HIPAA compliance for dentistry. We discuss the latest regulatory information, answer frequently asked questions and give suggestions for dental practices to make compliance easy and sustainable. The Compliance Divas are a trusted source for consistent, accurate information based upon current guidelines, standards, science, and recommendations.
The Compliance Divas Podcast
Episode #16 OSHA Citations: Learn from Actual Dental Violations
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The DIVAS share stories about OSHA’s top citations issued in dentistry. Learn what to do and what NOT to do to avoid costly citations. Find out what OSHA looks for when they conduct an audit in a dental practice and how you can be prepared.
Welcome. I'm Leslie Canum. I'm Mary Gavoni.
SPEAKER_02I'm Linda Harvey. I'm Olivia Wan. And together we are the Compliance Divas.
SPEAKER_00Hello everyone. This is Leslie Cannum. I'm your moderator for this episode of the Compliance Divas podcast. And what we're going to focus on today are OSHA citations in dentistry and how you can avoid them. We bring clarity and simplicity to compliance by navigating the regulatory compliance environment to keep you on course. Subscribe to the Compliance Divas podcast through your favorite podcast channel or on our website at thecompliancedivas.com. The resources that we mentioned during our presentation today can be found on the compliance divas website, thecompliancedivas.com. And we certainly welcome any questions that you have or comments that you'd like to share with us at support at thecompliancedivas.com. Well, let's get right down to it. OSHA citations are not fun for anyone. So what do we need to do to avoid them? First, what I'd like to do is talk about what OSHA standards, a dental practice needs to follow. We have the bloodborne pathogen standard. We have the hazard communication standard. And now we also have the respiratory protection standard that we need to play pay close attention to. There are other parts of the OSHA regulations that apply to dental offices, such as ionizing radiation and safety, portable fire extinguishers, and other areas concerning uh sanitation. But what I'd like to do is spend just a few minutes with Mary so she can tell us how we might discover what citations are even issued in dentistry. Because a lot of times I hear dentists tell us that as a consultant, I get called into offices after an OSHA audit has been conducted, after a dentist has been in trouble, or when they're afraid that somebody's going to report them to OSHA. But many times I hear dentists say by and large that OSHA pretty much leaves dentistry alone. Well, in my opinion, if you're driving a car without a seatbelt, you're not going to have a problem. No one's going to do anything. You're not going to get a ticket unless you have an accident or get pulled over. So it's only at those uh circumstances that you wish that you had followed the regulations. Mary, can you tell us a little bit about how we can see what kind of citations are issued in dentistry?
SPEAKER_01Absolutely, Leslie. And the other thing I think that is important for our listeners to know is that OSHA doesn't just look at issues with bloodborne pathogens and hazard communication. The reach of OSHA goes all the way back to the very beginning of the Occupational Safety and Health Act and the general duty clause, which says that employers must provide a workplace safe from recognized hazards that may cause injuries. And so they look at things like trip and fall hazards that aren't discussed in bloodborne pathogens. And even looking at electrical safety, I can remember in the early days of inspections that were happening as a result of the bloodborne pathogen standard before OSHA stopped doing unannounced inspections in dental practices. There were many practices that were cited for not having ground fault interrupters in their labs. If they had an older office and the building code didn't require them, but you are required to have a GFI outlet near a sink or near a source of water. And the dentists were just really offended by that. How dare they look at that? Well, that's their job to make sure that those injuries don't happen. So there's a really great tool that any dental practice or any dental team member can utilize from OSHA, which is called the establishment search. So if you just do a web search for OSHA, establishment search, you will come to a page that will ask you how or what do you want to search. And so you can just on this page, you can say that you want to research dental practices or dental offices. I usually just put in dental and you can sort your results by the states, or you can say all states, the default is all states. You can do federal and state OSHA plans, and you can say which OSHA office, which again would limit it to a state or a region, or you can even put a zip code if you want to know where OSHA inspections have happened in your zip code. And then you can um search by violations, whether the case has been closed. In other words, the inspection has been completed and all the abatements, the fixes have been made. And then you can search by dates, so a period of time that you can search by. So I'm looking at this right now on my computer, and I've done a search from the beginning of January 2020 through now, through the middle of July. And there are 66 um types of inspections that have been done over all the states. And that doesn't seem like a large number, but it has increased. If I went back historically, it's about doubled what we would see in dental practices prior to COVID-19. And so the thing to keep in mind is that there may not be a lot of these that are listed on this site, or if you go and you do a search, there is now again that threat of unannounced inspections because of the national emphasis program. So you can get, if the case is closed, you can get detail about the specific violations that have been cited. And I think perhaps Olivia or Linda may be talking about what it means for a willful violation versus negligence, the difference, or whether it's a repeat violation and so forth. And it's not enough just to survive, if you will, an OSHA inspection. If OSHA does come in and they cite you and they find you, they expect you to fix the problems and they do come back to make sure that you have. And if you don't, then you get a repeat violation for the same infraction. So that information is there. We'll put the link in the resources on the compliancedevas.com website. But doing an establishment search will help you with a lot of good information.
SPEAKER_00Thank you, Mary. And I think sometimes we just need a little push. Um, someone on the team may bring it to the attention of the other team members that uh they feel that we're uh in uh at fault and there's something that there's a violation. Everyone says, oh, you know, OSHA never bothers dental offices. They can go to this uh particular link you're talking about and say, well, yes, they do. And here's some other officers that have been cited for exactly what I'm talking about. Linda, um, could you tell us a little bit about those COVID-related violations that we've been seeing just lately?
SPEAKER_03Sure, Leslie. And we we started seeing COVID uh violations and citations as far back as last year early on. And what I'd like to do as far as some introductory remarks before I delve into three specific cases is that I want to mention that when we talk about compliance and the applicable regulations, I wanted to make the point to our listeners that we're talking about the OSHA regulations for general industry. And so this applies to all of healthcare and other types of businesses that would fall into the dental realm as well as other types of industries. So I wanted to make that point because when I get to the first example, that will make that point will make sense. And also the second point that I'd like to make is that OSHA finding dental practices, OSHA investigating dental practices, and OSHA complaints from about dental practices are not new. And I'd like to share one from a while ago. This one is back in 2008. And as Mary said, from day one, you know, we've had to comply. And there's been a history of dental practices that have been fined. We just don't hear about it and see it as much as we do now because we're so sensitive to all the things happening with COVID and trying to stay abreast of the current information. So this particular practice was in the New England area, and they were facing a fine of $76,000 related to an employee injury, uh needle stick and post-exposure follow-up that was not handled properly according to the blood-borne pathogen standard. Now, I know we're talking about COVID-related things, but just drawing the point again to the fact that OSHA compliance is not new in dentistry. And so it's important that we stay abreast of all these different regulations that we need to be in compliance with and no one understand what those compliance requirements are. So then looking at three specific areas, Leslie, of compliance and OSHA citations related to COVID, the first one is not a dental practice, but a dental company, a dental sales company that did not follow their state-approved OSHA plan and ended up with a fine of just over $5,000. This particular breach or pardon me, violation happened back pre-COVID vaccinations. This actually happened, you know, last summer. So as a result of that, you know, the main thrust was that they did not have a written COVID plan. And with this COVID plan, you know, we're required to have, you know, the reporting aspects, record keeping, accessibility of and of and the types of PPE that are available. They didn't maintain records, you know, of written implementation of the program, training and so forth. But the part of the fine that garnered the biggest fine, or part of the violations that garnered the biggest fine, which was $4,500, was that they were not social distancing at lunch. So again, remember, this was pre-vaccination era. So when thinking about now that we're in a vaccination era, and what does that mean for our fully vaccinated team members? Yes, they can't eat lunch together. Of course, that would be within six feet. You will obviously have your mask off. However, unvaccinated team members cannot participate in that level of um the practice. They have to be six feet apart or eat at a different time, or perhaps, you know, have a different schedule for lunch. So that's something that would be different to bear in mind now. The second violation happened last fall, and this happened with the Massachusetts dental practice that had a $9,500 settlement. And this one was specifically COVID-related and specifically respiratory protection standard, had a number of violations in that area. They had not conducted the required medical evaluations, which are part of a respiratory protection plan in order to ensure that your team are medically cleared to be wearing an N95 respirator mask. And then secondarily, you must do the FIT testing. And they had not conducted the FIT testing either. And they did not have a written respiratory protection plan in place. In addition, as we've mentioned, I think in other podcasts, when OSHA comes in, they don't have to stay with that one in that lane with that particular violation. The door can be open for them to look at other areas of the practice. And so, in doing so, they um the inspector found that they were lacking in the area of bloodborne pathogen training and controls for bloodborne pathogens. And they were lacking in that their eyewash station was insufficient. So I'd like to uh remind our listeners that the Divas have uh conducted a podcast on eyewatch station. So I would refer you to look at that podcast or listen to that podcast if you hadn't to take out some really good tips for your practice and maintain that compliance. It's a small area, but when OSHA comes in, just tidying up all the small details makes a big difference. And a third violation I'd like to share is from Michigan. And Michigan, like several other states, uh, has its own OSHA-approved bloodborne pathogen standard and uh has specific COVID guidelines for that state. And back in December, there was a dental practice that was fined $2,100 for violation of the MyOSHA COVID-19 requirements. And I'd like to list off, just if I can, six or seven of the areas where there was the citation and the deficiencies. This office was not, first, this office was not using personal protective equipment while performing tasks that were likely to generate splashing or spattering of bodily fluids, in particular, the violation mentioned that they weren't using face shields. Second, they had not installed physical barriers at the reception area, those sneeze guards. Third, they had not ensured that the patients had donned their own face covering. So patients were walking through the office, not wearing source control masking. They had not screened all the health care, dental healthcare personnel for COVID-19 symptoms. So even in December, offices were getting a little bit more relaxed because, you know, of course, the vaccines weren't quite released then, but you know, we were kind of getting a little bit worn and getting a little bit lax in our protocols. They had not developed an infectious disease preparedness and response plan. They had not provided COVID-19 training to team members. Um, and this is something that can be so simple. I know that many of our uh listeners and even our clients enjoy going to CE programs in addition to maybe having our training as our personal clients. But even though we may team members may be attending COVID-19 and OSHA CE courses, that's all great. But USHA wants to know what have you done for your office for training? So this would be documenting that you've had a team meeting and going over your policies and procedures and your COVID protocols so that you have information to validate that you have fulfilled that requirement. This is not unique to Michigan, this would be nationwide. But then back to related to this particular violation, two more. So we're not done yet, not posting the visual alerts about hand and respiratory hygiene and wearing a face mask. The CDC has a multitude of downloadable posters that a practice can post in the reception area. I think sometimes we get again focused on aesthetics in dentistry. And I mentioned that on our podcast on the sharps containers and sharps injuries that we focus on the aesthetics of not wanting to look like a clinic and we want to look like a relaxing spa environment, and yet we're not compliant. And then not requiring respiratory protection was the last one. So, Leslie, those are just a couple of examples. And I know as we go along, our other divas have had similar experiences and can share more, but just for our listeners to know, this is this is real. And OSHA has always been um dental has always been open to OSHA inspections and vines for non-compliance.
SPEAKER_00Thank you, Linda. And you know, all that you mentioned was really COVID-related. And I think a lot of us felt like we just wanted to be able to go back to working in dentistry and go back to the things we know. We've always been very good with infection control and OSHA training is required every year. But now with all these new uh regulations and restrictions that we had to look at, it certainly got a lot of folks in trouble when they thought they were probably doing all the right things. Olivia, can you tell us about inspections? You know, sometimes we we uh would have a surprise inspection, we didn't realize we're going to be inspected, and then other times we may have somebody that has threatened to go to OSHA, and so we have an idea that OSHA's coming, we have a little bit of a head start on thinking about what we need to do. Can you tell us a little bit about what to expect?
SPEAKER_02Sure, thank you, Leslie. So OSHA does have inspection priorities. You know, during the COVID pandemic, OSHA was receiving hundreds and hundreds of complaints each week. But regardless if it's pandemic period or not, OSHA has priorities in conducting an inspection. And so if there's risk of imminent danger, that would be the very first priority. And in my dealings with OSHA in dental offices, OSHA perceives the risk of a needle stick as imminent danger, and they would definitely make that a priority visit. Of course, if there's risk of severe injury, if a worker makes a complaint, uh, OSHA will evaluate the complaint to determine if it warrants an inspection. Sometimes it may just result in a letter. And if they're not satisfied to the response to the letter, then it would result in a visit. It could be a referral. Maybe the complaint was made to the Department of Health or the dental board, and those regulatory bodies referred it to OSHA for investigation. It could be part of a targeted inspection. For example, uh, Tennessee has this program, local emphasis program, which targeted dental offices for not being safe. So that could result in a random visit. Also part of the national emphasis program as it relates to COVID. And so understanding the priorities of an OSHA visit might help us to work through this maze and understand what triggers an inspection in the first place. And then if you do have an inspection, people wonder, you know, what exactly takes place. And so I want to emphasize that the OSHA person that visits your office would provide verification of their credentials. So they just don't walk in and start looking around. They would show you their credentials, whether they have a badge or a card. And they would have an opening conference with the dental office to let them know why they were there and what the scope of the visit is. And then that would be followed by what they call a walkaround. Now, in dealing with so many random visits in Tennessee, I actually wrote an article on how to handle an inspection. And I let OSHA review it before we published on our blog for accuracy of the facts. And so what we suggest is that, you know, if you have an unannounced visit, obviously that results in a lot of stress and people being nervous. So what we have suggested over the years is that you invite the safety officer to a private office or even a consult room and provide all of the paperwork documentation first. So your OSHA manual that has all of the safety plans, your quality control records, your safety data sheet collection, whether it's online or paper, uh, your employee medical records, whatever your the paperwork they're going to be asking for, allow them the time to review the paperwork. Do not do not place them in a break room that has contaminated lab jackets on the backs of the chairs. So you should always be in a state of readiness for OSHA to come in. But after they look at the paperwork, they will want to do this walk around. And part of that walk around is to interview individual staff members and ask questions. And so to prepare your staff for a visit like this during a training program or part of your meetings that you have as a team would be to ask some questions. For example, one of the questions we asked during a mock audit is uh can you please find the safety data sheet for your surface disinfectant? Or it might even be the ultrasonic cleaner. And we time it to see how long it takes to produce it and if they can even produce it at all. But people need to be comfortable being asked questions because it's not phone a friend. OSHA will ask employees questions individually and privately to see if those questions can be answered properly and not relying on one person who has all the knowledge and the information. Another thing that I would like to suggest, based on my experience, is please be respectful of the officer. Answer the questions that they ask in a respectful manner, don't be defensive and mad or saying, you know, why are we the ones to be inspected? You know, dental office down the street, they're doing XYZ and they're not, you know, the fact is you're the one that's being audited. So just provide the information, just be kind and caring, and that will go a long way. Because I remember years back, I dealt with a dental office that the dental assistant was rude. And she smarted off to the officer. And I really feel that's why the dental practice ended up with so many citations because she made the officer mad right out of the gate. And so please be respectful and considerate. They're just doing their job. Uh now, if someone made a complaint, and I know this is uncomfortable when a fellow team member has made a complaint and it gets back to you who it was. Uh, please don't take action against that person. If they had a concern and they contacted OSHA, uh, don't do anything drastic and emotional because that could trigger violation of the whistleblower act. And I actually dealt with a case like that, Leslie, where uh one of the assistants made a complaint and she was new. And, you know, obviously we would have preferred for her to ask questions about the program, but she thought that things were not set up correctly in the sterilization area, and she jumped the gun and filed a complaint. And I actually was the one that worked through the complaint with OSHA, and it was not legit. I mean, we worked through the facts and things were set up correctly. Well, the dentist was so upset that she actually fired the assistant because she was hurt and she was mad and she was embarrassed. Well, then that made more problems to have to deal with because it did violate the whistleblower act. And then we had to work through all those issues. And so please, if you're not familiar on how to deal with an OSHA inspection or a violation, uh, contact your people that you have in place or a knowledgeable consultant like one of the divas to help you deal with the facts at hand and work through that. So I hope that's helpful, Leslie.
SPEAKER_00Olivia, it is helpful. I think our listeners want to know what they should be prepared for in the event that they're selected for an audit and uh also understand how to respond. Um, you certainly can uh be uh upset that you have been uh identified as a target for an audit, but um it's important not to uh also suffer a whistleblower violation because I understand those fines can be quite hefty as well. What I'd like to do now is just ask all of our divas to share with us some of the OSHA violations uh that you have encountered among uh either uh clients or or uh from other uh situations that may have been presented to you at meetings. I know a lot of times I'll have after I speak on OSHA, a doctor will come up to me and share what happened when OSHA came to their office. So I know everyone wants to know how to avoid OSHA citations, and I'd like to hear from you all uh what those citations are and the lessons learned. Who would like to go first?
SPEAKER_01I'll go first, Leslie. Um the and Olivia sort of alluded to this earlier. If the the uh OSHA safety officer is there, let them see all the paperwork first because things will go better for you if they know that you've paid attention to what you need to have for documentation. So the one of the best ways to avoid is make sure that you dust off those manuals, make sure you update your infection control, exposure control plan on an annual basis, which the bloodborne pathogen standard requires. Make sure your hazard communication standard plan, your medical waste plan are all up to date. And OSHA will accept electronic copies. So if you don't want to have the big binder with all the papers in it, you can have everything available on your server so you can pull it up as long as everyone knows where it is and how to access it. But having your paperwork in order, because even a lack of documentation of training can be up to a $10,000 fine. And OSHA's assumption always will be that if you haven't documented something like training or having safety data sheets on hand, um, whether it's electronic or paper copies, that you haven't done it. So documentation is king in this in this case. That's the one of the best ways to avoid very costly citations.
SPEAKER_00That's great, Mary. And you know, uh one thing that I think our listeners would need to know is that not only is the OSHA bloodborne pathogen training required annually, but you also need to have that documentation on file for three years back. So if you haven't done it, you can't reproduce it. A tip to everyone listening would be to if you haven't had your annual bloodborne pathogen training, get that scheduled this month. Olivia, you have something to add.
SPEAKER_02I've had lots of OSHA violations that associated to improper handling of sharps injuries, primarily needle sticks, where the incident was not reported correctly, it was not addressed correctly or timely. And that resulted in OSHA making a site visit. And then the next result was pointing out all of the other transgressions that took place in the office. And then I would say, Leslie, the next thing that seems to trick up a lot of dental practices is not having their written plans, and if they have the plans not being current. And uh, as Mary said, you can't just dust them off. And one of the violations that I worked through with the dental practice, the team did not know where the safety policies were located. So not only was the dentist cited because the plans were not current, when they interviewed each individual team member, they did not know where the policies were stored. So if you store the documents electronically, which is fine, as Linda pointed out, then rehearse how to find it, that everyone knows that they're being titled, you know, in a consistent manner, that you know how to find them. If you're keeping a paper copy, that's fine too. But where is it? How can they find them and put their hands on them quickly? So those are some of the common ones over the years that we have worked through. And I hope the listeners find that helpful.
SPEAKER_00It's almost like saying, wouldn't it be fun to have a scavenger hunt of all these things as part of your team meeting? And uh you know, find uh who can find the eyewash station, who can find the SDS book, and where are our emergency action plans? And and uh then maybe a little round robin among the team. Okay, and Ocean Spectors is in our reception room. You know, how do we respond to the questions? And you know, it would be a lot of fun to do that as part of team training, maybe even include some prizes for the winners. Linda, you had something to add.
SPEAKER_03Leslie, in addition to what Livia just mentioned, um, you know, it underscores the importance of having office-specific training so that you're able to locate your binders if they're electronic or if they're physical, because hard copies, because maybe you have new members, team members on board, and how to find your safety data sheets or look something up in that binder, or if it's an online binder, how to search it. And so while many of us provide CE courses and we enjoy having audiences, we we have to always remind everybody that it's important to go back and have a brief team meeting. It doesn't have to be that long, but something that goes back and ensures that you've gone through these specific protocols and aspects of your practice that might end up being questions by an inspector. You know, where's the binder? Can you find this? And so forth. I would like to mention though, uh I think it was neither Mary or Olivia mentioned this that being an inspection writer, that state of readiness. And inspection writing may be challenging these days. And I think we'd all agree with our offices that are experiencing some issues with being short-staffed or not being able to find or recruit, you know, um, you know, qualified team members. And I'd like to refer everybody to a podcast that we did a little while ago on the safety coordinators and revisit that if you haven't listened to it, regarding some tips for supporting this role, especially in this COVID era. I think that's very important, Leslie.
SPEAKER_00Well, thank you, Linda. There's a few other things that I think are common uh things that are cited for uh certain situations in dental offices, not having the proper PPE, uh, you know, not having the proper eyewear. I uh had mentioned on our eye wash station uh podcast that uh one dental assistant had accidentally gotten some bleach in her eye when she was pouring bleach into a syringe for irrigation instead of drawing it up from a cup. Uh and uh so when she went to the hospital, there was an OSHA referral that occurred. OSHA came to the dental office and it was very difficult, a lot of paperwork, a lot of uh time away from production for that dentist to demonstrate why we even use bleach in dentistry when that's considered to be highly corrosive. And um, another uh audit that occurred, they didn't have barriers on the keyboards and mice in the treatment rooms. And so the OSHA auditor considered that to be a safety and health violation. Earlier, we uh or an earlier podcast, we had uh a podcast about sharps containers, and and it was mentioned dumping the uh contents of smaller sharps containers into larger uh sharps containers. So um I consider sharps containers to be like the Roach Motel. Once something goes in, it doesn't come out, it stays in that sharps container. And uh so every now and then I'll hear a story of something that inadvertently went into the sharps container. I'm sure we have fun stories of how things go uh got into the trash and we had to dump the trash to look for it, like a crown, or in the old days, we have a burchuk for a handpiece. So if something like that were to go in the sharps container, what I'd always recommended is to um find the employer, the dentist employer, give them the sharps container, give them a force or cotton plier, and let them go fishing for it so that an employee is not placed at risk. Um, the another uh issue that came up as being um a $53,000 fine for one dentist, this one guy all by himself. He had two practices. And as was mentioned earlier, what they cited him on was he didn't have a bloodborne pathogen exposure control plan or hazard communication plan. He failed to require the use of appropriate gloves or personal protective equipment. He did not have a medical evaluation for an employee following an exposure incident, so he didn't have a good system for that emergency action plan that was mentioned. He failed to make the hepatitis B vaccination made available to all of his employees, or maybe he didn't have declination, maybe they were already vaccinated, and he didn't train his workers on chemical and bloodborne pathogen hazards and precautions. So, in taking um stock of all that we need to do when it comes to training, I think this podcast made it very clear that we need to make sure that we have the proper documentation. We need to know that that OSHA may come and we want to be able to respond appropriately, listen carefully to what they're asking for. I think that my brother's an attorney, and he told me that uh during a deposition, you know, you don't volunteer any more information, just what you're asked for. So, you know, uh have your ducks in a row, have your record keeping in order, take a deep breath and understand and let your team members know that the OSHA does have the right to interview people independently of the employer and ask questions. So we want to be prepared to answer those questions. It might be as simple as where's your fire extinguisher? And do you know how to use it? Show me your first aid kit and uh you know that all-important emergency action plan. So everyone knows step by step what to do in the event the unthinkable happens. You have a needle stick or an exposure incident, or someone needs to use the eyewash station that everybody knows, just like they know CPR, exactly what to do. I think we have covered a lot of ground in this particular uh podcast on OSHA citations and dentistry and how to avoid them. We bring clarity and simplicity to compliance by navigating the regulatory environment so you can stay on course. Please feel free to submit your questions to support at the compliance divas.com. We will have the resources that we mentioned for available for you on our website, and we hope that you will subscribe to our podcast so you can stay up to date with the most current information from the compliance divas. Thank you so much, everyone.