By Lee Slaton, Vice President of Healthcare; Smart TrainingThis article is one of a series of stories complied by the author, based on information obtained from Freedom of Information Act requests detailing OSHA investigations that ensued from complaints received by Federal or State-run OSH programs.
Although 22 states opt to manage their own OSH programs, all 50 states’ investigations are included in the federal government’s database of OSHA investigations.
Very notably, according to the latest calculations of inspections in this database, over 60% of OSHA investigations are generated by complaints.
As anyone who reads my articles knows, the point of them isn’t about the validity of the complaints—which in this case, was not disputed by the employer. It’s to show exactly how much havoc is wrought by investigations initiated by a complaint about a usually-easily preventable situation.
I always point out that a complaint (valid or not) results in letting the OSHA camel’s nose under the tent flap. In other words, once an OSHA investigation commences, all bets are off; anything an OSHA investigator sees is fair game.
In late January of this year, a state-run OSH plan received a complaint regarding a dental practice that led to a retelling of the familiar story: how a complaint regarding a particular incident led to an investigation where a litany of violations was discovered.
As you read this case, put yourself in the shoes of the practice owner. Ask yourself if these violations are occurring or could occur in your practice. The violations the OSHA investigator cited weren’t obscure ones brought to light in an attempt to justify the inspection. They were run-of-the-mill standards that should be in the daily playbook of every practice to keep employees and patients safe.
In the grand scheme of things, this practice got off with an extremely “light regulatory touch.”
How It Began
The genesis of this incident began with a new employee who was to assist with a dental procedure.
Note: There’s a reason OSHA requires employees receive safety training before their first work assignment: new employees are much more likely to be involved in workplace injuries. This case is a prime illustration of this point.
In this case, the employee didn’t receive all of her safety training before she began her first assignment and couldn’t find the proper PPE to wear during this procedure—specifically, eye protection.
The employee was directed by the assistant manager to obtain glasses from the countertop in the procedure room. The only glasses available were tinted glasses designed for patient use and only for UV protection. Interviews suggest the employee couldn’t see the procedure and briefly lifted the glasses as the dentist instructed her to provide suction. At that time, blood splattered into the employee’s eyes. Interviews with employees revealed that those were often the only available glasses, and employees are not trained on which PPE to wear.
Additionally, once the exposure occurred, the employee was unable to access an emergency eyewash station. The investigator’s notes indicated that one emergency eyewash station was not accessible and that interviews indicated the other station was often obstructed by equipment and instruments piled in the sink.
To further add insult to injury, after the incident, no post-exposure follow up was performed to determine how the exposure occurred, as was called for by the practice’s written operating procedure.
As I was reading the entire 205-page file detailing this incident and the additional uncovered violations, I was shaking my head on virtually every page. I felt like I was watching an episode of the “Keystone Kops” in slow motion.
Now that we know what precipitated the investigation, let’s see what else the investigators uncovered.
29 CFR 1910.1030 — Bloodborne Pathogen Standard: Multiple Violations
1910.1030(c)(1)(iv) — The Exposure Control Plan shall be reviewed and updated at least annually and whenever necessary to reflect new or modified tasks and procedures which affect occupational exposure and to reflect new or revised employee positions with occupational exposure.
“The employer provided a generic written program for establishments covered in all states provided by the risk manager. The practice did not complete an annual review of the Exposure Control Plan provided at the time of inspection.”
1910.1030(f)(2)(i) — Hepatitis B vaccination shall be made available after the employee has received the training required in paragraph (g)(2)(vii)(I) and within 10 working days of initial assignment to all employees who have occupational exposure unless the employee has previously received the complete hepatitis B vaccination series, antibody testing has revealed that the employee is immune, or the vaccine is contraindicated for medical reasons.
“Interviews suggest that the vaccinations were not offered to employees and the Office Manager was not aware of this requirement. The Office Manager, who does not have a clinical background, is responsible for the day to day oversight and supervision of clinical staff.”
1910.1030(f)(3)(i) — Post-exposure Evaluation and Follow-up. Following a report of an exposure incident, the employer shall make immediately available to the exposed employee a confidential medical evaluation and follow-up, including at least the following elements: Documentation of the route(s) of exposure, and the circumstances under which the exposure incident occurred.
“The practice did not conduct a post evaluation follow-up to determine how the exposure occurred when an employee had blood splashed in the eye during a procedure.”
1910.1030(g)(2)(vii)(G) — The training program shall contain at a minimum the following elements: Information on the types, proper use, location, removal, handling, decontamination and disposal of personal protective equipment.
“The practice did not train employees on the types of personal protective equipment available or the proper use required to assist with dental procedures.”
1910.1030(g)(2)(i) — The employer shall train each employee with occupational exposure in accordance with the requirements of this section. Such training must be provided at no cost to the employee and during working hours. The employer shall institute a training program and ensure employee participation in the program.
“The practice failed to train all employees with occupational exposure to the hazards associated with blood and other potentially infectious material at the time of initial assignment.”
29 CFR 1910.132 — Personal Protective Equipment (Additional Standard Violated)
1910.132(d)(2) — The employer shall verify that the required workplace hazard assessment has been performed through a written certification that identifies the workplace evaluated; the person certifying that the evaluation has been performed; the date(s) of the hazard assessment; and, which identifies the document as a certification of hazard assessment.
“The practice did not certify that a hazard assessment was performed to determine the type of personal protective equipment necessary for employees assisting with dental procedures.”
Closing Thoughts
At Smart Training, we see far too many of these investigations and ensuing violations. The time to address deficiencies in your safety programs—like the ones detailed above—is not after an accident occurs or a complaint (no matter how frivolous it seems) is lodged. The time to address them is before something bad happens!
It’s not rocket science to implement a comprehensive safety program. Anyone can do it; just as almost anyone can change the oil in their car though they may not do as good a job as a pro, or be using their time in the best way.
If you don’t have the time or inclination to implement a safety program on your own, with a little help from an expert, it’s not a heavy lift to make your practice a compliant and safer place for your employees and patients.