TOSHA believes the information in this presentation to be accurate and delivers this presentation as a community service. As such, it is an academic presentation which cannot apply to every specific fact or situation; nor is it a substitute for any provisions of 29 CFR Part 1910 and/or Part 1926 of the Occupational Safety and Health Standards as adopted by the Tennessee Department of Labor and Workforce Development or of the Occupational Safety and Health Rules of the Tennessee Department of Labor and Workforce Development. TOSHA required: Safety & Health Programs For Dentistry Bloodborne Pathogens Exposure Control Plan Sharps Injury Prevention Sharps Injury Log Hazard Communication Plan Hazard Assessment for Selection of PPE TB Emergency Action Plan http://www.osha.gov/SLTC/dent istry/control.html Bloodborne Pathogens 1910.1030 Written Exposure Control Program (ECP) Engineering Controls (safer medical devices) Personal Protective Equipment Hepatitis-B vaccine and Antibody Test Confidential Follow-up (Exposure Incident) Bio-Hazard Labels Initial and Annual Training Sharps Injury Log / Sharps Injury Prevention http://osha.gov/SLTC/bloodbornepath ogens/indes.html Other Potentially Infectious Materials--OPIM Semen Vaginal secretions Cerebrospinal fluid Pleural fluid Pericardial fluid Peritoneal fluid Amniotic fluid Saliva in dental procedures Any visibly contaminated body fluid Any body fluid where differentiation is difficult Any unfixed tissue or organ Universal Precautions (Standard Precautions) Must be observed Include in Exposure Control Plan What is/are universal precautions? All blood and body fluids are treated as if known to be infected with HIV, HBV, HCV, etc. Engineering and Work Practice Controls Safety Engineered Devices Hand-washing facilities No Recapping, bending, breaking, shearing, etc. of needles No Eating, drinking in the workplace Handling, storing, transporting specimen Personal Protective Equipment Parenteral exposure stick or cut Mucous membrane splash Non-intact skin spill or splash gloves gowns glasses/ goggles masks pocket masks Housekeeping Written cleaning schedule Decontaminate with appropriate disinfectant http://www.epa.gov/oppad001/chemregindex.ht m EPA registered tuberculocidal disinfectant EPA registered disinfectant with label stating it is effective against HIV and HBV Household bleach, diluted 1:10-1:100, made fresh daily Ensure correct contact time (let air dry w/bleach) Regulated Waste Sharps containers Immediate Disposal Needles Blades Broken glass Red bags Liquid or semi-liquid blood or OPIM Items caked with dried blood or OPIM Items that could release blood or OPIM Pathological waste Microbiological waste HBV Vaccinations Offer to all persons with reasonably anticipated exposure to blood or OPIM Offered within ten working days of initial exposure At no cost to the employee Test for antibody to Hepatitis B surface antigen 1-2 months after completion of the threedose vaccination series Sign declination statement Labels Fluorescent orange or orange-red background Letters in contrasting color Regulated waste Refrigerators/freezer Containers used to store, ship, transport contaminated reusable equipment – dental “picks” Training For all employees listed in the Exposure Determination At no cost to employees During working hours At the time of initial assignment Annually--within 1 year of last training date Must be opportunity for interactive questions and answers Train employees on adopted safer needle devices before implementation Bloodborne Pathogens and specifics of site Exposure Control Plan Exposure Control Plan Training What does "Universal Precautions" mean? (Universal Precautions – all human blood and certain human body fluids are treated as if known to be infectious for HIV, HBV, and other bloodborne pathogens.) What do you do when there is a blood or OPIM spill? What personal protective equipment must be worn during cleanup? What cleanup and disposal procedures are used? What disinfection procedures are used (what are the chemical hazards of the sanitizers used and what is the contact time)? (PPE worn if sprayed?) Have you been offered an HBV vaccination series free of charge? Titer? Declination statement? Doctor’s Written Opinion? Where is the employer's written Bloodborne Pathogen Exposure Control Plan, has it been explained to you, and have you been trained in its procedures? The Needlestick Problem Among healthcare workers, there are an estimated 600,000 to 800,000 percutaneous injuries occur each year Many needle-sticks are not reported 2006 – TOSHA Special Emphasis – Ambulatory Surgery Centers & Hospitals – In 2012, a 22% reduction Problem with Sharps Up to 80% of All Accidental Exposures to Blood Are Caused by Needle-sticks and Other Contaminated Sharps. Source: OSHA: “Safer Medical Devices: Protecting Healthcare Workers” 1997 Needle sticks in Dental Practice 1/3 of exposures - non- disposable local anaesthetic syringes, usually during removal and disposal of the needle. “20-26” exposures within 1 million hours worked. “0” exposures with safety occurred within 1 million man hours. **Needle sheath prop – one handed removal technique Sharps Injury Prevention Each employer must use “Safer Medical Devices” that are appropriate, commercially available, and effective: Employers can no longer refuse to buy safety devices because of cost or lack of efficacy data Sharps with engineered sharps-injury protections; Needle-less systems NOTE: definitions added to the revised standard January 18, 2001. Sharps Injury Log / Sharps Injury Prevention Confidential Type and brand of device involved in the incident Department or work area where the exposure incident occurred Explanation of how the incident occurred Action resulted from investigation prevention Infection Control: Recommendations Practices for the dental laboratory Receiving area Incoming cases Disposal of waste materials Production area Outgoing cases CDC http://www.cdc.gov/mmwr/ preview/mmwrhtml/rr5217 a1.htm Hazard Communication/GHS 1910.1200 Written Program – http://www.state.tn.us/labor -wfd/Wtdbooklet.pdf Safety Data Sheet for each product containing hazardous chemicals All chemical products must be labeled - mixtures Training on specific chemicals used, hazards, first aid, and prevention GHS – December 1th, 2013 GHS Elements Classification A description of the hazard and its severity. For example: Reproductive Toxicity: Category 2 Hazard Statements Standardized phrases and codes that describe the nature of the hazard. For example: H315 - Causes skin irritation Precautionary Statements Standardized phrases and codes giving advice about the correct management of chemical substances and mixtures. For example: P264 - Wash hands thoroughly after handling Signal Words Words that are used to emphasize hazards and indicate the relative level of severity of the hazard. For example: Danger or Warning Pictograms Symbols that indicate the health, physical or environmental hazards. Pictograms GHS Pictograms and Hazard Classes Physical Oxidizers Flammable Self Reactives Pyrophorics Self-Heating Emits Flammable Gas Organic Peroxides Explosives (Divisions 1.1 to 1.4 only) Self Reactives Organic Peroxides Corrosive to Metals Health Acute Toxicity (severe) Gas Under Pressure Environmental Carcinogen Respiratory Sensitizer Reproductive Toxicity Target Organ Toxicity Mutagenicity Aspiration Toxicity Irritant Dermal Sensitizer Acute Toxicity (harmful) Skin Corrosion Serious Eye Damage/ Eye Irritation Aquatic Toxicity (acute) Aquatic Toxicity (chronic) Hazard Communication Labels Each container of hazardous chemicals must be labeled with the: Identity Hazard warning Name/address chemical manufacturer GHS Label must cross-reference with the SDS and chemical inventory entry Labels Safety Data Sheets For each hazardous chemical No SDS is required for: Drugs in solid, final form for direct administration to patients (pills, tablets) Consumer products where the employer can show: It is used in the workplace for the purpose intended Duration and frequency of use is not different from that of the consumer Must be available to employees while they are in their work areas Safety Data Sheet Info In English New 16-section format Sections must be in order as dictated in Appendix D Appendix D details the information to be included under each heading Same as ANSI Z400.1 Compliance date for chemical manufactures, imports and distributors —June 1, 2015 Safety Data Sheet Sections Section 1, Identification; Section 2, Hazard(s) identification; Section 3, Composition/information on ingredients; (Section 4, First-aid measures; Section 5, Fire-fighting measures; Section 6, Accidental release measures; Section 7, Handling and storage; (Section 8, Exposure controls/personal protection; Section 9, Physical and chemical properties; Section 10, Stability and reactivity; Section 11, Toxicological information. Note 1 to paragraph (g)(2): To be consistent with the GHS, an SDS must also include the following headings in this order: Section 12, Ecological information; Section 13, Disposal considerations; (Section 14, Transport information; and Section 15, Regulatory information. Note 2 to paragraph (g)(2): OSHA will not be enforcing information requirements in sections 12 through 15, as these areas are not under its jurisdiction. Section 16, Other information, including date of preparation or last revision. Hazard Communication Training Before employees are exposed Initially & Annually, per Tennessee Right to Know Law Training must be “effective,” i.e., employees must be able to recall basic information Hazard Communication Training What are the requirements of the hazard communication standard? What hazardous chemical(s) are you exposed or may be exposed to during normal use or in a foreseeable emergency? Where is this chemical present? What are the short and long term effects on the body? How can you detect if you are overexposed to the chemical? How can you protect yourself from overexposure? Where are the SDS, chemical list, and written program located? Plus Two More for GHS What information must be on the label on containers of hazardous chemicals? What do the pictograms indicate? Specific Employer Requirements for PPE Programs Hazard Assessment Written Certification of Assessment is Required Workplace evaluated Person doing the certification Date of the assessment Id of the document as a ppe certification Training Written Certification of Training Name of employee Dates of training Subject of certification ADA & OSHA ALLIANCE - Ergonomics In 2005 the Alliance calls for OSHA and the ADA to explore ways to determine whether ergonomics instruction is currently being included in dental schools' educational programs, and then encourage the incorporation of sound and proven ergonomics techniques into such curricula. Both organizations will also speak, exhibit and appear at conferences, local meetings or other events, and also disseminate information for dental employees through the media and from both organization's websites. Concluded April 2010. No results posted yet…. http://www.osha.gov/dcsp/alliances/ada/ada.html#pr oducts – ergo tools for dentistry Emergency Action Plan Must be in writing* Minimal plan elements: Emergency escape procedures Procedures for critical plant operations Accounting for all personnel Rescue and medical duties Means of reporting fires and other emergencies Contacts for further information Types of evacuations *Employers with 10 or less employees may communicate the plan orally and need not maintain a written plan. Postings “It’s the Law” Poster Get info on starting new business at: http://www.tennessee.g ov/ecd/res_guide.htm Citations Nitrous Oxide OSHA Document-Anesthetic Gases:Guideline for Workplace Exposures Hazard Communication MSDS, Information and Training, chemical list and training on health effects, labels ACGIH TLV-50ppm Health effects-reproductive & CNS Follow manufactures guide on machine care & maintenance Nitrous oxide (N2O) is used to increase an engine's power output by allowing more fuel to be burned than would normally be the case Nitrous Oxide NIOSH Technical Report-Control of Nitrous Oxide in Dental Operatories DHHS (NIOSH) Publication No. 94-129 1-800-35-NIOSH TB Required if treat reasonably suspect individuals – free health care clinic to homeless with three confirmed cases Establish risk from Health Department Establish testing – PPD two step then annual one step Train on the signs and symptoms of TB http://www.osha.gov/SLTC/etools/ hospital/hazards/tb/tb.html#Re spiratoryProtection & http://www.cdc.gov/nchstp/t b/webcourses/CoreCurr/inde x.htm TOSHA Resources www.osha.gov www.state.tn.us/labor-wfd www.cdc.gov www.cdc.gov/niosh Memphis Office 901-543-7259 Jackson Office 731-423-5640 Nashville Office 615-741-2793 1-800-249-8510 Knoxville Office 865-594-6180 Kingsport Office 423-224-2042 Chattanooga 423-634-6424 Consultative Services 1-800-325-9901 Questions?