Dental professionals may be at risk of exposure to numerous workplace hazards. The federal Occupational Safety and Health Administration (OSHA) and the state of California have legal requirements for employers to create and maintain safe workplaces. California dental offices must meet infection control and safety standards, including those that address bloodborne pathogens and biological agents, for both federal and state agencies.
OSHA’s Bloodborne Pathogen Standard applies to all employers with employees who have occupational exposure to blood or other potentially infectious materials, regardless of how many workers are employed.
The Dentists Insurance Company handles workers’ compensation claims related to a wide range of workplace incidents, but the most common reported injuries are from needlesticks. These injuries can put health care workers at risk of exposure to bloodborne pathogens, including hepatitis B, hepatitis C and HIV.
It is no surprise then, that to be compliant with Cal/OSHA standards, California dental practices are required to train any team member who may be exposed to bloodborne pathogens. What might come as a surprise to practice leaders is that this training is required by both federal and Cal/OSHA on a yearly basis. Confusion exists because many assume the standards for bloodborne pathogen training are the same as those for infection control training, which is required by the Dental Board of California to be completed every two years.
When a sharps injury does occur, practice owners are responsible for managing the possible exposure to bloodborne pathogens. The Dentists Insurance Company’s Advice Line often receives calls regarding how to handle exposures and mitigate liabilities.
A Common Scenario
In one case reported to TDIC’s Advice Line, a full-time dental assistant had just completed assisting a dentist with a root canal procedure. In a rush to prepare the operatory for the next patient, the assistant failed to notice that the needle was not capped. While hurrying to gather the instruments, she punctured her right thumb with the needle, then reported the incident to the dentist.
When the dentist called the Advice Line for guidance, the TDIC analyst reminded the dentist that wounds that have been in contact with blood or bodily fluids should be washed with soap and water. Additionally, the dentist must properly document the needlestick incident in a sharps injury log, which is required by law in most jurisdictions.
The dentist inquired if it would be acceptable to contact the source patient and request that she undergo testing. He also inquired about his responsibility to cover any cost associated with patient testing. The analyst advised the dentist that it is a best practice to send the source patient for testing and discussed opening a claim to cover the source testing under his TDIC Professional & Dental Business Liability policy.
Mitigating Risks Through Exposure Plans
Due to the potentially serious consequences of a needlestick incident, the Cal/OSHA Bloodborne Pathogens Standard requires dental practices of every size to have post-exposure plans in place. Essential plan components include:
- Immediate reporting of a needlestick injury to the dentist.
- Forms documenting the exposure and, when necessary, employee or source patient refusal of medical evaluation or testing.
- A sharps injury log.
- A preselected physician from the medical provider network (MPN), the referral list provided by the workers’ compensation carrier, who can evaluate the exposed dental professional within 24 hours.
TDIC advises dentists to report any sharps or needlestick incidents to their workers’ compensation and professional liability insurance carriers for coverage of employee testing and source patient testing. Employers are required to pay for any medical treatment related to the bloodborne pathogen exposure. However, all workers’ compensation policies, including TDIC’s, cover this for employees in the event of a needlestick injury.
Needlesticks: Prevalent but Preventable
While employee needlestick injuries in the dental setting are common, training and safety protocols can help prevent them. “I typically see needlestick injuries arising from employees moving too quickly as they are recapping used needles,” notes Karen Schaffner, workers’ compensation manager for TDIC. The injuries frequently occur when breaking down instrument trays following a procedure, in a recurring pattern of hurrying to clean up and prepare for the next patient.
Your Safety Obligations
To help reduce the risk of needlestick accidents and exposure to bloodborne pathogens, dentists are required to use “standard precautions” and to have a pre-exposure control plan with details on employee protection measures. This plan must specify the use of a combination of engineering and work practice controls.
Work practice controls include:
- Personal protective clothing.
- Training on sharps use and disposal, including not bending or breaking needles prior to disposal.
- Medical surveillance and hepatitis B vaccinations.
- Signs and labels.
Engineering controls include:
- Safety syringes designed to eliminate recapping and removing the needle after use.
- Sharps containers.
- Strict observance of the “full” line on sharps containers.
Other Resources to Support Your Practice
In the state of California, employers are required to provide form DWC-1 to an employee for completion within one business day of becoming aware of a work-related injury or illness. Both TDIC and CDA offer additional resources for education, training and information about compliance with Cal/OSHA requirements for bloodborne pathogen exposure management.
TDIC policyholders can sign in to tdicinsurance.com to access:
- A downloadable form to document an employee’s refusal of post-exposure evaluation.
- Straightforward ways to initiate a quote or request assistance with workers’ compensation insurance designed for dental practices.
- A workers’ compensation claims kit, which includes important required forms and postings such as DWC-1, DWC-7 and Form 5020.
Policyholders who have not yet created an online access account may do so at tdicinsurance.com/Account-Overview.
CDA members can log in to cda.org to access downloadable resources:
- Bloodborne pathogens exposure management protocol.
- A list of safety sharps providers compiled by CDA Practice Support.
- Sets of required posters about safety and employee rights, regularly updated with the latest information.
Members also have access to affordable online training:
- CDA’s Bloodborne Pathogens Online Training Program is a convenient way to earn C.E. and meet requirements while training your team and working together to build your exposure control plan.
Take time to explore the tools and expertise available through organized dentistry. Then, develop your exposure plan with your team and pursue the bloodborne pathogens training that protects you and your practice team. Any time TDIC policyholders or CDA members have questions about bloodborne pathogen exposure or other compliance concerns, TDIC’s Risk Management Advice Line is ready to offer expert guidance.
TDIC’s Risk Management Advice Line is a benefit of CDA membership. Schedule a consultation with an experienced risk management analyst or call1.877.269.8844. Reprinted with permission from the California Dental Association, copyright July 2022.