I had the privilege of presenting a seminar to the clients of Henry Schein Dental, topic “Dental Practice Act”. The seminar was held at their new facility located at 3900 Atherton Rd, Suite 100, Rocklin, CA. Great turn out and support, the Henry Schein team was fantastic!

Q: We get children who have problems with keeping the x-ray sensor in their mouth because of gagging or discomfort. A staff member  is required to stay in the room with the patient and hold the sensor in place while another staff member presses the button to take the x-ray. The staff has discussed concerns about radiation exposure with the employer, the employer suggest that we wear a radiation apron when in the room while holding the sensor. Is this safe?

A: NO it is not safe and it is a violation of OSHA, Department of Health Services and Consumers Affairs regulations. I would advise your employer to purchase the proper sensor for children, the cost would be cheap compared to the citations, fine and potential lawsuit by employees!

If you received “OSHA” training, you only received five percent of the needed information to be compliant and reduce risk to yourself and patients. OSHA training is not,

• The Dental Practice Act
• Sterilization
• Patient Safety
• Dental Board Infection Control
• HIPAA
• Radiation Safety
• Environmental Heath Management
• Human Recourses

Dental Professionals must look beyond the “OSHA mentality” and take responsibility to find out what they need in order to be competent in their duties. They also need to change their mindset from doing only the minimum to adding value in everything they do.

All businesses that obtain and maintain healthcare information must provide the highest standards to protect the information from accidental or deliberate misuse or disclosure.

• New patient information is verified with a driver’s license or state issued ID.
• Insurance information is verified with a driver’s license or state issued ID
• Credit card transaction is verified with a driver’s license or state issued ID
• Third-Party Disclosure

Patient information is disclosed to third-party entities for the following purposes only,

• For treatment
• To obtain payment for treatment
• For healthcare operations

Control Accidental Disclosure - work practices that reasonably prevent accidental disclosure must be exercised at all times.  From a simple procedure of covering protected health information to locking-up unattended filing cabinets, to being aware of the surroundings when discussing patient information is vital.  In addition, patient’s protected health information should never be discussed out-side of work under any circumstances or for any reasons.

Restrict the use of Patient Information - the patient’s protected health information (PHI) must be used for healthcare related purposes only.

Apply the Minimum Necessary Rule – the concept of the “Minimum Necessary Rule” is that the very minimum of protected health information (PHI) be used, accessed or released for any purpose or task even if an exception is permitted.

No Marketing Activity – at no time protected health information may be sold or transferred to any third party for the purpose of marketing activity, whether for profit or not, or to introduce a person, business, product, or service.

Control Electronic Transmissions – prior to transmitting protected health information (PHI) on electronic devices such as computers, fax machines, voice mail, and telephones, it must be determined whether it is secured and if confidentially will be maintained and not compromised.

Control Discarding Protected Health Information – all documents that contain protected health information (PHI) when discarded must be shredded or destroyed, to prevent disclosure.  At no time documents containing protected health information are discarded if confidentiality will be compromised.

HIPAA and Patient Information Security is achieved only when employees are well trained, well informed and apply what they have learned.

Before using chemical products or any product for that matter, first read the label. If you do not understand the instructions ask management before using the product. Take the time and steps necessary to be safe!

The following is a basic checklist for waste management, be sure to check with your State, County and City agencies for specific requirements.

Amalgam/Mercury

• An Amalgam/Mercury management plan that includes the policies & procedures for handling and discarding Amalgam/Mercury is established and all staff members have reviewed.
• Amalgam Safes are located in each operatory where amalgam is placed.
• Trap filters are in use and maintained in each operatory. When amalgam is placed or removed traps are discarded in an Amalgam Waste Container which is removed by a waste management service.
• Empty amalgam capsules are discarded in the Amalgam Waste Container.
• An Amalgam/Mercury Separator is in use.  (either by regulation or by voluntary)
• If an Amalgam/Mercury Separator is not in use, the vacuum filter is discarded in the Amalgam Waste Container.
• Only Amalgam/Mercury Separator safe vacuum line cleaner is used.  (Read the label of the vacuum line cleaner before using and determine if safe with separators)
• Staff receives yearly training on Amalgam/Mercury management.

Hazardous Waste Materials

Most Cities and Counties have a “Zero Tolerance Policy” when it comes to discharging chemicals and hazardous materials into waste system.  The following common items, if used, must be removed by a waste management service,

• Lead
• Fixer
• Sharps
• Amalgam/Mercury (unused & scrap)

Note: Lead and Amalgam must be properly contained and the container clearly marked.  An Amalgam Safe is highly recommended.  Your Waste Management will advise you as to the proper storage containers to be used.

• Developer
• Vapor-Sterile
• Pharmaceuticals
• Cold Sterile (containing glutaraldehyde)

Universal Waste Rule

The State’s Universal Waste Rule prohibits specific items to be discarded into the standard trash system, therefore must be collected and discarded properly.  Check with your city (home & business) website for additional information.  The following are basic items,

• Used Batteries
• Fluorescent Tubes
• Electronic Devices
• Electronic Components
• Vapor Filled Light Bulbs
• Compressed propellant items
• Staff receives yearly training on Hazardous Waste management.

Waste Management Recordkeeping

• When waste products are removed from the office, a record in the form of a manifest or receipt must be obtained.  (Self-contained systems are exempt)
• Manifest must indicates each item that is removed from the business. Manifest that “group” items is not acceptable.
• Manifests are stored in a binder or folder in an organized manner.

It is amazing how often I am asked “What’s new with OSHA?  When the question should be “What’s new with Dental Compliance?”

Why?  its simple; Dental Offices are regulated by more than OSHA, depending on the county and city your practice is located in; it can be as many as seven agencies!

However, if you look beyond your OSHA training and gain an understanding of the compliance makeup you will also gain an appreciation that compliance regulation is an essential part of your business operations, both in growing your practice and maintaining your practice, not to mention reducing financial risk. Today compliance has taken on a whole new meaning, it is no longer a back office issue; it is a “total” practice philosophy.  Compliance is good – good for the staff, good for the patient and good for the practice.  So think “Dental Compliance” and not just OSHA.

Assuming that new hires both experience and inexperienced know what to do to maintain the standard of your office is risky business. Take the time and orientate all new hires to the policies and procedures of your office and constantly test their understanding of your standard. I suggest conducting a New Employee Orientation for the first ten days of employment and longer if needed, the areas of focus should be patient safety, patient information security, infection control, OSHA, Consumer Affairs and office policies & procedures. The key to successfully maintaining a standard is making sure everyone is on the same page. By the way, employee training should be conducted a minimum of once a year and for maximum results onsite!