By Lee Slaton, Vice President of Healthcare; Smart TrainingNIOSH (the National Institute of Occupational Safety and Health) announced Respiratory Protection Week will be observed this week, Sept. 7–10, 2021. Yes, you read that right. How fitting with today’s subject!
I also find it very ironic, as observations from the field in Texas indicate a growing number of dental healthcare personnel (DHCP) are choosing to dismiss CDC guidelines regarding the use of respirators during aerosol generating procedures during what has become the worst wave of the pandemic so far.
The question I don’t have the answer to is, why? Is it a result of burnout in having to require staff to deal with a burdensome procedure? Ignorance of CDC guidelines for dental settings in the midst of seemingly changing recommendations? Or a response of relief when TSBDE declined to extend the COVID-19 Emergency Rule that required DHCP to wear respirators during AGPs? For this argument’s sake, I’m going to go with door no. 3: taking one’s foot off the gas after TSBDE’s Emergency Rule expired.
Here’s what’s posted on the TSBDE website:
At the June 18, 2021, Board meeting, the TSBDE voted to allow the COVID-19 emergency rule 108.7 to expire. Dental professionals are encouraged to continue following the Centers for Disease Control and Prevention’s Guidance for Dental Settings.
Unfortunately, the combination of less-than-stellar vaccination rates and Delta—the much more virulent version of COVID-19—becoming the primary variant, the pandemic has become worse since June 18. As of this writing, Friday, Sept. 3, the community transmission rate in 246 of Texas’ 254 counties is rated at moderate, substantial, or high. That’s 97% of the state’s counties.
Dentists in 97% of Texas counties should be using respirators for AGPs now.
Despite the challenges of changing recommendations across the spectrum, the CDC’s COVID-19 guidance for dental settings has been remarkably steady since Dec. 4 . My take is, the main reason it’s been able to maintain that steady state is they set up their guidelines based on levels of community transmission rates.
The most prominent line of demarcation for determining who should be doing what is in CDC’s guideline to “Implement Universal Use of Personal Protective Equipment (PPE), based on the level of community transmission”. This guideline is broken into two:
1. For DHCP working in facilities located in areas with no to minimal community transmission and
2. For DHCP working in facilities located in areas with moderate to substantial community transmission.
The biggest difference between the two guidelines is the recommendation to use respirators when performing AGPs in facilities located in areas with moderate or higher levels of community transmission. That means, if you’re in one of those 246 Texas counties, the CDC says you should be using respirators for AGPs.
I’m not going to bore you with the guidelines themselves. They’re pretty easy reading. Below are two important links that back up everything I just shared with you:
- The COVID-19 Data Tracker web page. This is updated every day at 7 p.m. Central. You can easily see where your county stands. Here’s that link:
- CDC COVID-19 Guidance for Dental Settings
Yes, you can be fined.
For those of you who might be thinking along the lines of “But, Lee—those are only guidelines; and they’re from the CDC, not OSHA. The CDC can’t fine me,” that is a flawed argument. I can put you in a meeting or on the phone with an OSHA inspector in any OSHA area office in the country who will tell you otherwise. In case you’ve never read the OSH Act, here’s what SEC. 5 states:
(1) outlines: Duties – (a) Each employer—(1) shall furnish to each of his employees employment and a place of employment which are free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees.
That’s known as the General Duty Clause, and OSHA inspectors can and do use it to cite employers who put their employees into harm’s way through their actions or inactions. OSHA can and does use guidance from other regulatory or advisory bodies, such as NIOSH and the CDC, when their own standards do not address potential hazards to employees.
Let’s put OSHA aside for a moment. In the field of dentistry, we’ve relied on CDC guidelines for years to provide many of the guardrails that keep our staff and patients safe and healthy. Most state dental board regulations refer to CDC guidelines, as well. In fact, many states’ dental regulations incorporate CDC guidelines by reference; Texas included.
Bottom line: You’re in the healthcare business. Like it or not, your chosen profession is science-based and highly regulated. As Sgt. Esterhaus used to say at the end of his shift briefing on Hill Street Blues, “Let’s be careful out there!”