As a business owner, you're legally bound by standards issued by the Occupational Safety and Health Administration (OSHA) to provide a safe working environment for your employees. Even if you're a one-person operation and your business is incorporated, you are considered an employee and are subject to OSHA regulations.
Therefore, it's your responsibility to familiarize yourself with all applicable standards set forth by OSHA. Given the scope of the regulations—covering everything from electrical wiring and housekeeping to training employees and preventing contact with infectious materials—that can be a somewhat daunting task. In addition to staying abreast of OSHA regulations, laboratory owners who want to ensure they're in compliance attend courses, designate one person in the laboratory to oversee its health and safety program or enlist the help of safety consultants. "It's so hard to run the laboratory and still know everything you need to know about OSHA, so I've found that it's worth it to pay someone who specializes in it," says Vinnie Abate, CDT, MDT, owner of York/Cerama Laboratories in New Haven, Connecticut.
But even those laboratory owners totally committed to health and safety efforts have received visits from OSHA—most often triggered by a complaint from a former employee. And, because of the number of regulations and the sometimes difficult task of interpreting them, it's unlikely that an inspection won't turn up at least a few violations. So which regulations trip us up most often?
Listed below in order are the 10 OSHA violations issued most frequently to dental laboratories in states that are regulated by the federal OSHA program*. Since the first two standards—Hazard Communication and Bloodborne Pathogens—are violated far more often than the others, LMT decided to take a closer look at how they apply to dental laboratories. (Please note that this list includes highlights of the standards only; for full text, visit www.osha.gov.)
Violation 1. Hazard Communication.
The largest number of OSHA violations—across almost every industry—fall into this category. Intended to reduce the incidence of chemically related occupational illnesses and injuries, this standard is also referred to as the "worker right-to-know"standard. Following are some of its key elements:
Hazard communication plan. This plan states in writing your methods of complying with the Hazard Communication Standard including your systems for container labeling, maintaining Material Safety Data Sheets (MSDS), conducting employee training, etc.
Maintain a file of MSDSs. OSHA requires that you have copies of the MSDS for each hazardous material in your laboratory and that they are accessible to employees at all times. (Federal law requires manufacturers and distributors of products containing hazardous substances to furnish customers with MSDSs.)
"The biggest problem we've seen with MSDSs is the recall system. Often, when laboratories get an MSDS, they put it into a drawer and can't find it when they need it," says Ricky Hochhauser of American Dental Supply, which provides safety training to laboratories. "We recommend they have two files: one in the laboratory area so it's accessible to technicians, and one in the administrative office as a backup."
Keep an updated hazardous substance inventory. You must maintain a master inventory list of hazardous materials in the laboratory, including items such as etching acids, disinfectants, pickling agents and flux. You can check the MSDS to see whether a chemical is hazardous or not. The name used on the inventory list must match the name used on the MSDS.
Labeling protocol. All containers must be labeled with their contents and any hazard warnings. The name and address of the manufacturer must also be listed. In most cases, the manufacturer, supplier or distributor will already have labeled the container satisfactorily, but it's your responsibility to check for accuracy and completeness and to relabel it if necessary.
Keep in mind that every container in the laboratory must be labeled. During its February 2000 OSHA inspection, York/Cerama Laboratories received a $500 fine for each of several unlabeled bottles of water. "If you can't tell a porcelain water bottle from a bottle of acid, then you're in trouble," says Abate. "You might know what it is, but you can't guarantee that nobody will ever mistake one for the other."
Employee training program. The standard requires employee training, including:
- The Hazard Communication Standard.
- The components of your written program and where it's located.
- Your lab's labeling system.
- Discussion of procedures in hazardous work areas where exposure to chemicals may occur.
- Emergency procedures.
- The inventory list of hazardous chemicals.
- The location and meaning of MSDSs.
The training must be provided to all new hires, to employees using a new product that contains hazardous chemicals and as a periodic "refresher course." Be sure that you keep records, including dates, a summary of the training program and names and signatures of participants (signatures should be witnessed by another person).
Violation 2. Bloodborne Pathogens.
The objective of this standard is to limit occupational exposure to potentially infectious materials that could result in the transmission of diseases such as hepatitis B or HIV. In the dental laboratory, it applies to saliva or blood on incoming impressions, models and appliances sent in for repair. Following are some key elements of the standard:
Exposure Control Plan is a written plan that identifies tasks, procedures and job positions where exposure to bodily fluids occurs. You must classify employees according to their level of exposure: Category 1 employees have a direct exposure to blood and body fluids and Category 2 employees don't have exposure.
"In addition to those in the receiving area, Category 1 employees are those working with clinically poured models or doing repairs and relines, and those doing pick up and delivery and shadetaking," says Mary Borg of SafeLink, a safety consulting company in Gainesville, Georgia. "Examples of Category 2 employees are waxers; ceramists, as long as they're not taking shades; and metal finishers who don't do repairs."
The Plan must also include standard operating procedures for risk areas, including disinfection procedures for incoming cases. It must be accessible to employees and should be reviewed and updated at least annually, when new procedures are implemented, or when employee positions are revised.
Universal precautions mandate: You and your employees must practice universal precautions, meaning that you should treat every case that comes through the door as though it is carrying an infectious disease. Although OSHA doesn't set specific disinfection methods for dental laboratories, it does require that you control employees' exposure to bloodborne pathogens. (For more on preventing cross-contamination, see Cross contamination: the risk and the reality)
Work practices. Your lab must have handwashing facilities including single-use towels; eyewash stations connected only to cold-water faucets; and personal protective equipment such as gowns and gloves. The standard also prohibits eating, drinking, smoking and applying cosmetics in work areas.
As the employer, you're expected to enforce all aspects of the standard. Since his OSHA inspection, Abate says he's forced to discipline or suspend employees when they violate the no-drinking-or-eating-at-the-bench policy. "It's something you wouldn't ordinarily think about because a lot of us have done it, but it's ultimately the laboratory's responsibility to be sure everyone is taking the necessary precautions," he says.
The standard also requires a written schedule and protocol for waste disposal, laundering lab coats and cleaning of the laboratory, including cleaning contaminated surfaces and equipment. A common violation for dental laboratories is the failure to disinfect plaster traps, pumice and equipment used for denture repairs.
Hepatitis B vaccination: Because employees who have exposure to bloodborne pathogens can be at risk of contracting hepatitis B from an infected case, OSHA requires that you provide all Category 1 employees with vaccinations, at no cost to them, within 10 days of being hired. Employees who refuse the vaccination must sign a declination form but can later opt to receive the vaccine at the laboratory's expense.
But the employee can't sign just any declination. "There's specific information that OSHA expects to see on the declination form," says Emery Burdine, CDT, owner of Dental Dynamics, Arlington, Texas. During an August 2000 inspection, the inspector pointed out to Burdine that the forms he was using did not have the necessary information. Check OSHA's website (www.osha.gov) for the appropriate statement.
Information and training. Like the Hazard Communication standard, this standard also requires employee training that covers:
- An explanation of the Bloodborne Pathogens standard.
- Bloodborne diseases and their transmission.
- Steps that the laboratory is taking to minimize risk.
- Personal protective equipment.
- Hepatitis B vaccine.
- How to handle emergencies involving blood.
- What to do in case of exposure.
The training should be conducted for all new employees and at least annually for all employees. One laboratory, Georgia Dental Laboratory in Tucker, Georgia, was cited (but not fined) for holding its annual training just one month past the one-year anniversary of its previous session. The training was delayed because of scheduling conflicts.
Keep records, including dates, summary of the training program and names and signatures of those employees who participated (again, the signatures must be witnessed).
Violation 3. Log and summary of occupational injuries and illnesses.
This standard requires you to keep a list of all work-related injuries and illnesses sustained by your employees during the calendar year. From February 1 to March 1 of each year, you must post the list from the previous year—minus the employees' names—and keep the list in your records for five years.
Although this federal OSHA standard only applies to businesses with 11 or more employees, you may want to keep the log no matter what the size of your laboratory. "We tell our clients that it's an excellent resource to have at the end of the year because if a number of accidents happened in the same area of the lab or under similar circumstances, then you know where you need to focus additional training or inspection," says Borg.
Violation 4. Respiratory protection.
OSHA requires that your first step in regulating air quality is with engineering controls such as ventilation, suction or substitution of less toxic materials. However, because those controls can't ensure that the air is totally safe in a dental laboratory, you should also provide respiratory protection such as masks certified by the National Institute for Occupational Safety and Health.
The standard also requires you to have a written respiratory program that outlines how you select, test, inspect and maintain the equipment. Employees must also be trained on how to use the mask and ensure an accurate fit.
Violation 5. Portable fire extinguishers.
The requirements of this standard apply to the placement, use, maintenance and testing of portable fire extinguishers. There are three types of extinguishers:
- Class A for ordinary combustibles
- Class B for flammable liquids
- Class C for energized electrical equipment
Depending on the type of extinguisher, it must be placed within 50 to 75 feet of employees' work areas.
Someone in the laboratory must be responsible for inspecting them monthly, keeping records, and training employees who may need to use them. They must also be serviced annually by your local fire department or a fire protection services company.
Violation 6. Wiring methods, components, and equipment for general use.
Although OSHA has a host of electrical regulations, this one applies specifically to wiring in ducts and in damp or wet locations; circuits; conductors; flexible cords and cables; and wiring on appliances, lamps and motors. For example, during an OSHA inspection eight years ago, one Florida dental laboratory was cited for items such as improper power strips, lack of ground fault outlets near sinks and model trimmers, unmounted extension cords, incorrect wiring under a sink and not having three-prong plugs on some equipment.
Violation 7. Posting of notice; availability of the Act, regulations and applicable standards.
OSHA poster #2203 may be one of the first things an inspector looks for when he enters your laboratory. It itemizes employer obligations, employee rights and contact information for OSHA. (Poster #3165 is a new, full-color version of #2203 and is downloadable from www.osha.gov.)
The poster must be displayed in an obvious place in your laboratory and not obstructed; for example, if you place it on a bulletin board, be sure that no one tacks something over it.
Violation 8. Means of E-gress, general.
Be sure exits are marked with exit signs and are not obstructed. If you have a door marked as an exit that is usually locked, everyone in the laboratory must have the ability to unlock it; otherwise, don't mark it as an exit.
Violation 9. Personal protective equipment.
It is your responsibility to recognize hazards in the laboratory and provide personal protective equipment such as gloves, gowns and masks. A common mistake that many laboratories make is not enforcing the use of it. At Georgia Dental Laboratory, for example, some technicians in the model department weren't wearing eye protection during the inspection, costing the laboratory a $525 fine. "We provide the equipment and educate employees about the importance of using it, but the inspector said that wasn't enough," says Debbie Jarvis, human resources director. "Now we've had to indicate in our employee manual that failure to wear personal protective equipment is subject to disciplinary action and could result in termination."
Violation 10. Access to employee exposure and medical records.
This standard requires that you keep a separate medical file for each employee who has suffered a workplace-related illness or injury. The file has to be kept completely confidential, and can be accessed only by the employee.
*As of September, 2001, state-operated programs exist in Alaska, Arizona, California, Hawaii, Indiana, Iowa, Kentucky, Maryland, Michigan, Minnesota, Nevada, New Mexico, North Carolina, Oregon, Puerto Rico, South Carolina, Tennessee, Utah, Vermont, Virgin Islands, Virginia, Washington and Wyoming. These state plans have been approved and are partially funded by the federal government. All other states fall under the auspices of federal OSHA.
Looking for help?
Check the OSHA website at www.osha.gov and look for the section dedicated to small businesses. Also, contact one of the following companies that offer safety training and OSHA compliance programs specific to dental laboratories:
American Dental Supply, Inc. 800-558-5925 610-252-1464 contactADS@aol.com
SafeLink 800-330-6003 770-205-6745 firstname.lastname@example.org