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A healthy practice must have safety built into the culture.
The devil, they say, it is in the details. And while it is true that your infection control efforts must involve such details as personal protective equipment, regular staff training, and proper hand hygiene, you must also build a culture of safety to guide the practice.
OSHA may seem like the bogeyman, and the practice may not want them sniffing around, for fear that they would find the worst, but OSHA can come in and assess the practice for areas where they may need some help.
“OSHA Consultation provides a free health and safety consultation service for employers with fewer than 250 employees and no more than 500 employees, corporate-wide,” Mary Borg-Bartlett, President SafeLink Consulting says. “Many employers fear inviting OSHA in, however, it can be beneficial by protecting the employer during the year of the visit from OSHA penalties.”
This service will help the practice identify issues in any number of areas.
“During the visit,” Borg-Bartlett continues, “Consultation will help the employer 1) identify physical hazards throughout the facility; 2) evaluate all technical programs; and 3) review the safety and health program management. Recommendations will be made on how to correct physical hazards and improve both the technical programs and the safety and health management system. The employer must agree to make any corrections that are discovered during the visit.”
An OSHA visit need not be a lengthy, comprehensive undertaking. If there is just one area that the practice is not sure about, OSHA can focus its attention on just that.
“OSHA Consultation visits can also be limited to certain hazards,” Borg-Bartlett says. “For instance, if an employer needs to focus on complying with the Bloodborne Pathogen Standard, then they could limit the consultation to that area. Another would be for conducting air sampling to ensure that dust collection systems and other ventilation is adequately exhausting dust and fumes from hazardous chemicals. This can be a very expensive service when an independent Industrial Hygienist is hired to conduct this air monitoring.”
In addition to OSHA, there are other consultants that can help, including the employer’s worker’s compensation carrier. Inviting in such a consultation does, however, come with a caveat.
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“Most of these carriers will have staff who can conduct a safety assessment,” Borg-Bartlett says. “Remember, however, that when inviting in the insurance company, you will be exposing the hazards in the workplace. A situation that I am familiar with was a client who used this type of service and the insurance carrier found that many hazardous chemicals were present in the workplace. They then required that the employer hire an Industrial Hygienist to verify that the workers were not at risk. Using your carrier, however, for an ergonomics assessment can be very helpful, as it is expensive to hire an ergonomic specialist.”
There are several independent consultants who focus their efforts, expertise and energy on dental practices.
“When qualifying these consultants, we recommend that the employer find a firm that is knowledgeable in the employer’s industry,” Borg-Bartlett says. “Dentistry is an example, as it requires a consultant who is knowledgeable not only about biological hazards, but also chemicals, electrical hazards, machine guarding, radiation, etc. A qualification that an employer can look for is either a degree in occupational safety and health or authorization as an Outreach Trainer under OSHA’s Outreach Program. Consider requesting references from the consultant and contacting the references.
“A real value of working with a consultant familiar with your industry is that they can develop the programs for you, help you keep them updated, and if you have a continuing relationship with the consultant, they can keep you abreast of changes that could affect your safety program. They usually provide safety training programs to assist you with meeting your new hire and annual employee training requirements.”
Simple, repeatable and safe
Dr. Stephen Dowell, DDS, a general and cosmetic dentist in Ohio, says that for his practices, there is a basic guiding concept for infection control.
“Every year our local dental society has different speakers come in,” Dr. Dowell says. “Some of the different speakers would put up products, recommend products, so we kind of go through it and figure out what would be simple and safe. We want it to be simple, repeatable and safe. We want to do it all the time, not worry about it, and know that it protects us, because I consider us all young. Granted, I’ve been in practice 28 years, but we’re all still practicing, we’re going to keep practicing, we want to be safe, we want to see ourselves and see our families here.
"We want to know that when we see our families, there are no problems. We don’t want to worry about it. So, what can we do to protect ourselves, protect our families, and not worry? If you think of it that way, it becomes easy. Then we start finding products that are that way. We’ve heard different things, ‘You could do it this way or that way,’ but I’d rather do it this way. It’s safer this way. Or we know this company is a safe company to work with.”
Dr. Dowell says that he and his staff constantly evaluate products, based on research from a number of sources, both internal and external.
“We find out from reading, from consultants, from other doctors, and from our sales reps,” Dr. Dowell says. “We work with Schein, for the most part, and we say, ‘Hey, we are looking for monitoring strips,’ and we asked our consultant, ‘We want to make sure our stuff is coming out every time.’ She says, ‘Try this company.’ Okay. We did and it worked out well. We heard people say, ‘You’re doing too much. Put some autoclave tape in the kits.’ So, I have a sterilization technician who is an assistant and she does all of our instruments. And she said, ‘No, it’s not going to work that way. It’s better to use the strips.’ Okay, every cassette gets a strip. And that’s my point about it being simple. We don’t have to worry about it. It comes out, we open up the kit, if it’s good, it’s good to go. If it’s not, we take it back to the sterilization room and we get another kit. We don’t worry about it.”
From there, Dr. Dowell says his practice uses good, old-fashioned hands-on assessment.
“We’ll test things out,” Dr. Dowell says. “We’ll get something in, we’ll look at it, we’ll test it. Is it working or not working? If we have a problem with it, we’ll call then back and say, ‘It’s not working. We need another product.’ So that’s how we do it. We’ve got a group of people here that are all concerned.”
Evaluation, he says, involves everyone at the practice.
“It’s truly a team effort,” Dr. Dowell says. “The whole team, together, when we have our morning huddle, when we have quarterly meetings, we ask, ‘Does anybody have any issues with products?’ And they’ll say, ‘We tried this product. We like this product. It works well.’ Okay, great. It’s truly a team effort. The whole team has input on trying to find something better, something different, something they can do all the time. Then we'll get samples in. Samples are really helpful, because a lot of times, we will call our rep and the company will send us a sample of this or a sample of that. When we go to the trade shows, we find out different things, and we will try them, we will talk to them. And that helps immensely.”
Even when Dr. Dowell and his staff have found a product or service that they like, their evaluation does not stop.
“We are constantly revisiting it, all the time,” Dr. Dowell says. “It’s the same with dental products. Things come and go, things change and improve. We’re always looking and reading and checking on it. Our rep will come in once a month, usually, and we will say, ‘What’s the newest thing out there?’ And they’ll say, ‘This is.’ And our staff will say, ‘We saw this here. What do you think of this?’ We will ask questions. Sometimes the companies send us samples. Sometimes we will get samples with orders. We will try them out. ‘No, I don’t like this one.’ We’re constantly revisiting, constantly trying to improve on it. It’s kind of like being green. We’ve got high-speed evacuation tips. They’re recyclable. We are helping the environment, and were being safety conscious, all at the same time.”
For all the efforts that he and his team make, Dr. Dowell strongly recommends the use of a consultant, and even reaching out to your manufacturer representatives.
“A few years ago, we hired a consultant to come into our office, and actually walked through the office,” Dr. Dowell says. “We said, ‘Give us an opinion. We want to know how we’re doing. Is everything on par? Is everything where it should be?’ Then we’ll ask our Schein rep. ‘What do you think of this here?’”
He adds, “it helps to stay with reputable companies. Nowadays, we are finding that some of the people aren’t even trained for the products. The company will say one thing, and the reps will say something different. Who do you go to? Sometimes it is difficult, because different groups will say different things. That’s where it’s becoming difficult.”
While keeping up on the practical aspects of infection control is, of course, important, one must not lose sight of the bigger picture. That is, engendering a culture of safety helps ensure that patients and staff remain healthy and protected.