Regulatory Compliance: Cal/OSHA Citations of Dental Practices

CDA Practice Support

A review of Cal/OSHA dental facility inspection data from October 2016 to September 2021 provides useful information to dentists who seek to reduce compliance risk. A total of 37 dental practices were inspected during this period, 43 fewer dental practices than the previous five years. 1 The assumed reason for the significant drop in the number of inspections is the COVID-19 pandemic. Twenty-two of the 37 inspected facilities were cited for a total of 44 violations. All but one of the cited facilities had between 1 and 3 citations. One dental practice was cited for five violations. 2

The most common citation issued to dental facilities was for failing to have a written injury and illness prevention plan. Ten facilities did not have the required written plan. Facilities also were cited for:

■ Not having a system of communicating workplace hazards to employees.

■ Not having a procedure to investigate occupational injuries and illnesses.

■ Not maintaining records of scheduled and periodic inspections

One dental practice’s citation for not having a procedure to investigate occupational injuries and illnesses was part of the agency’s COVID-19 inspections. The citation, categorized as “serious,” has an initial penalty of $3,150 and is being contested at the time of this writing.

In addition to the items listed above, a written injury and illness prevention plan must:

■ Identify the person(s) with authority and responsibility for implementing the program.

■ Describe a system for ensuring employees comply with safe work practices, such as recognition program, disciplinary actions and training.

■ Include methods or procedures for correcting unsafe conditions or work practices.

If a dental practice claims exemption to the Cal/OSHA Aerosol Transmissible Disease (ATD) regulation, the plan must include procedures for screening patients for ATDs and management of patients suspected of having an ATD. A COVID-19 prevention plan must be either a standalone plan or an addendum to the injury and illness prevention plan. Sample plans are available on cda.org/practicesupport as part of the Regulatory Compliance Manual.

Several citations were issued for violations of the bloodborne pathogens regulation during this period. The violations included:

■ Failing to have a written exposure control plan.

■ Failing to have a sharps injury log.

■ Failing to record injury on sharps injury log within 14 working days.

■ Keeping food or drinks in refrigerators or freezers where blood or OPIM were present.

■ Failing to replace sharps container to avoid overfilling.

■ Failing to have appropriate container for regulated waste.

■ Failing to have appropriate PPE available. Dental practices also were cited for violations of these requirements:

■ Hazard communication: written plan, hazardous chemical list, labeling of containers of hazardous materials, staff training.

■ Electrical safety: adequate working space for equipment, adequate guarding of working space.

■ Sanitation: prevent uncontrolled accumulation of water that may lead to mold growth.

■ Sanitary facilities: separate toilet facilities for each gender (dependent on the number of employees).

■ First aid: adequate supplies or usability.

■ Emergency eye wash: availability.

■ Air tank: permit.

■ Fire extinguisher: provision of, inspection and testing, annual maintenance check.

■ Exit: unobstructed.

Cal/OSHA categorizes its citations by factors such as whether a violation was willful and by the extent and severity of the violation. A dental practice’s noncompliance with requirements for handling sharps safely was deemed a “serious” violation, and it resulted in a proposed penalty of $4,500. This is the section of the bloodborne pathogens regulation that was cited: I5193 (d)(3)(C) Requirements for Handling Contaminated Sharps.

1. All procedures involving the use of sharps in connection with patient care, such as withdrawing body fluids, accessing a vein or artery or administering vaccines, medications or fluids, shall be performed using effective patient-handling techniques and other methods designed to minimize the risk of a sharps injury.

2. Immediately or as soon as possible after use, contaminated sharps shall be placed in containers meeting the requirements of subsection (d)(3)(D) as applicable.

3. At all times during the use of sharps, containers for contaminated sharps shall be:

■ Easily accessible to personnel and located as close as is feasible to the immediate area where sharps are used or can be reasonably anticipated to be found (e.g., laundries);

■ Maintained upright throughout use, where feasible; and

■ Replaced as necessary to avoid overfilling.

A failure to report to Cal/OSHA a serious work-related injury or fatality led one dental practice to be cited. The citation and proposed penalty of $5,000 are being contested at the time of this writing. n

REFERENCES

1. Cal/OSHA Citations of Dental Practices. J Calif Dent Assoc 2017 May;45(5):261–2. 2. United States Department of Labor. OSHA Inspections Within Industry database. Accessed Feb. 10, 2022.