Fracturing OSHA protocol

April 1, 1999
More important than the doctor possibly getting into trouble for violating OSHA standards is the fact that the safety of your patients is being jeopardized.

More important than the doctor possibly getting into trouble for violating OSHA standards is the fact that the safety of your patients is being jeopardized.

Dianne Glasscoe, RDH, BS

Dear Dianne,

I graduated from dental hygiene school last year. With the abundance of dental hygienists in my area, the job market is quite competitive. However, I was fortunate to land a job in a general practice close to home.

I have been pleased with my position for the most part. However, one problem is causing me concern. The problem is that my office is quite lax regarding infection control. For example, I am expected to use the same handpiece all day without protective barriers. It is merely wiped off with a disinfectant after each use. In addition, the X-ray tube heads are not covered in plastic. I also have observed the doctor writing in patient charts with his contaminated gloves on. The dental assistants do not exercise proper dark- room asepsis, and instruments are sterilized on an open tray without being bagged to preserve sterility.

In school, we were taught strict infection-control guidelines. I firmly believe in using protective barriers for my patient`s benefit, as well as my own.

Since I am the youngest staff member, I feel uncomfortable trying to change the normal office routine. I don`t want to be labeled as a "know-it-all." But these OSHA infractions bother me a great deal. The doctor could get in a great deal of trouble if these violations were ever discovered. Can you advise me on how to handle this problem?

Lax in Louisiana

Dear Lax,

In my opinion, you have a serious problem on your hands. More important than the doctor possibly getting in trouble for violating OSHA standards is the fact that the safety of your patients is being jeopardized. No one wants to be responsible for passing some pathogen from one patient to another.

Things have sure changed in the last 20 years. When I graduated from dental hygiene school in 1978, we didn`t wear gloves unless we had an open wound on our hands or unless we had a patient who was ill. In those days, we felt gloves hindered tactile sensitivity excessively. Protective eyewear was optional, and masks were not worn. I even can remember a time when I was a dental assistant and we reused saliva ejectors. We just rinsed them out and put them in a disinfectant soak until the next day. This practice would be considered grossly inappropriate today.

When my children were small, I worked as a temporary hygienist in a four-city area. I had the opportunity to visit many dental offices during this time, and I can tell you that some of these offices were in serious violation of OSHA standards. I used to be very uncomfortable working where I didn`t feel infection control was up-to-par. Often, no autoclave bags or plastic barriers would be available for the handpiece, suction, or water syringe. If I voiced my concern, the doctor usually would brush off my comments with something like, "It`s no big deal. My assistants and I keep things very clean." I even had one doctor challenge me by requesting I send him some documentation to prove that what I suggested was in the OSHA code for dental offices ... and I promptly honored his request! I have found that some doctors choose to ignore certain protocol, probably because of the expense and inconvenience to the practice.

In my work as a consultant, I have observed various infractions of OSHA protocol. Usually, when my suggestions on tightening infection-control measures are delivered in a tactful manner, they are received graciously. In a consultation setting, I am being compensated for suggestions on improving the practice overall, and OSHA compliance is one area of observation.

Infection-control procedures that were acceptable several years ago are no longer acceptable today. I wonder if a doctor would be comfortable with my using an unprotected handpiece - one that had been used on nine other people that same day - on his wife or another member of his family? In recent years, the media has brought to the attention of the public a number of dental-office "faux pas" regarding ethics and infection control. Will we never learn?

Doctors who have been in practice for a number of years have a harder time changing the way things are done. However, there are numerous infection-control seminars given throughout the country each year. There simply is no excuse for being lax on infection control!

My suggestion is to "eat this elephant one bite at a time." Start with requesting bags to cover the X-ray tube head. After you start doing that, chances are that the dental assistants will follow suit. Then, request barriers for small items, like suction, syringe, etc. These barriers are very inexpensive. You might even attend an OSHA update seminar. You could then say, "I learned such-and-such at the meeting. Do you think it would be possible to ... ?" When the doctor sees that you have the best interests of the patient - and his practice - at heart, he probably will agree with the proposed changes. The important thing to remember is to approach this subject with tact. Do not demand that things be changed ... or else.

You are in a position to be a good example to the office with your current knowledge of infection control. I commend you for being unwilling to compromise the standards you learned in dental hygiene school. It`s sad to say, but some hygienists become lax after leaving school. In our `busyness,` we sometimes overlook such things as touching the patient chart, lead shield, pencils, etc., with contaminated gloves. You have reminded all of us that proper infection control really is important.

Even though it might be hard to teach an old dog new tricks, it is not impossible. Be patient ... and good luck!


Dianne Glasscoe, RDH, BS, is an adjunct instructor in clinical hygiene at Guilford Technical Community College. She holds a bachelor`s degree in human resource management and is a practice-management consultant, writer, and speaker. She may be contacted by e-mail at [email protected], phone (336) 472-3515, or fax (336) 472-5567.