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
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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
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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
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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
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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
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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
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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
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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
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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 –
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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
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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
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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
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Workplace evaluated
Person doing the
certification
Date of the assessment
Id of the document as a
ppe certification
 Training
 Written Certification of
Training
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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
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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?