Dr. Don's Dental Blog

Most common OSHA fine for dental practices

2012-02-19T09:23:00.001-08:00

Most common OSHA fine for medical practices

By: David LaHoda February 10th, 2012 of HCPRO

Q: In a medical practice what is the most frequent OSHA citation and fine?

A: Last year the most common OSHA citation issued to medical practices was for not having or updating the written exposure control plan, section 1910.1030 (C) (1) of the Bloodborne Pathogens standard, according to a report appearing in the September 2011 Medical Environment Update.

The average initial fine for that violation was $980.

The same was true for dental practices where the average initial fine for that violation was $1,008.

http://blogs.hcpro.com/osha/2012/02/ask-the-expert-most-common-osha-fine-for-medical-practices/

Managing Contaminated Surfaces

2012-02-16T09:49:00.000-08:00

From An Article by Eve Cuny BA MS

During dental hygiene procedures, surfaces and equipment within the operatory may become contaminated with oral fluids—either through direct contact with contaminated gloves, equipment, and instruments, or from aerosols and spatter generated during dental treatment. Equipment and instruments that come into direct contact with oral tissues should be cleaned and heat sterilized immediately after use, and disposable items should be promptly discarded. A number of noncritical surfaces and equipment that cannot be detached or sterilized are also subject to contamination during routine oral care. Managing these environmental surfaces is a critical aspect of infection control.
Standard precautions require that bodily fluids, with the exception of sweat, be considered potentially infectious. This is a core concept in infection control procedures, and it must be implemented for all patients regardless of their known or perceived infectious status. Because it is not possible to determine which patients have an infectious disease (due to lack of symptoms or omission during the health history), standard precautions remain a critical component of providing oral health care. Special precautions for patients with bloodborne diseases such as hepatitis B (HBV), hepatitis C (HCV), and human immunodeficiency virus (HIV), are not indicated and should not be implemented unless they are vital to patient health. Special precautions include: refraining from aerosoland spatter-producing procedures; extending instrument sterilization times; and presterilization of dental instruments. There is no evidence to suggest these practices are necessary or effective.¹
Aerosol and Spatter
Aerosols are particles smaller than 50 micrometers (µm).² Because of their small size, aerosol particles may remain suspended for extended periods before settling on environmental surfaces. Smaller aerosol particles (measuring 5 µm to 10 µm) remain airborne for even longer, and are small enough to enter the alveoli of the lungs.³
Larger-sized droplets (greater than 50 µm) are called spatter. Because spatter can travel with greater velocity than aerosols, it can contaminate surfaces that are located more than 12 inches from the fluid spray source.² Both aerosols and spatter can contaminate surfaces in the dental operatory. Touching contaminated surfaces increases the risk of cross-contamination from clinicians' hands to patients' oral tissues during treatment.
Surface Classification
Clinical surfaces are divided into two categories: clinical contact surfaces (Figure 1A), and housekeeping surfaces (Figure 1B). Clinical contact surfaces are subject to aerosol contamination created by handpieces and ultrasonic scalers, or surfaces that come in direct contact with clinicians' gloved hands (light handles, switches, drawer pulls, chair and equipment buttons and control knobs, chairside computers, faucet handles, and countertops). Although these surfaces have not been implicated in the transmission of diseases to patients or dental professionals, they can serve as a reservoir for microbial contamination.¹
The proper use of fluid-impervious barriers to protect clinical contact surfaces will prevent contamination. Barriers are particularly effective in protecting surfaces that are difficult to clean or would be damaged by contact with moisture or chemical disinfectants (Figure 2). Fluid-impervious barriers are available in a variety of shapes, styles, and materials, including plastic and plastic-backed paper. Because barriers may become contaminated during patient care, they should be changed and discarded by a gloved clinician between patients. After removing barriers, surfaces should be inspected and contaminated clinical contact surfaces should be cleaned and disinfected before new barriers are placed.¹
Clinical contact surfaces that have not been barrier-protected must be cleaned and disinfected between patients. The United States Centers for Disease Control and Prevention (CDC) recommends the use of a low to intermediate-level disinfectant registered with the US Environmental Protection Agency (EPA) as a hospital-level disinfectant. EPA-registered low-level disinfectants can inactivate HBV and HIV. Progesteronic intermediate-level disinfectants can inactivate Mycobacterium tuberculosis (TB). When a surface is contaminated with blood or other potentially infectious materials, dental professionals should use an intermediate-level disinfectant.¹ The use of an intermediate-level disinfectant for all cleaning and disinfecting may be the safest practice because not all contamination is visible.
There are no documented cases of disease transmission from housekeeping surfaces, such as floors, sinks, and walls.⁴ But, due to the risk of aerosol exposure, these surfaces should be cleaned with detergent and water. For spills of blood and other potentially infectious materials, cleaning with an EPA-registered hospital-level disinfectant is recommended.⁴
Disinfectant Selection
When selecting a disinfectant product for cleaning clinical contact surfaces, a number of factors should be considered, including: equipment manufacturers' recommendations on what is safe to use on their products; the product's ability to both clean and disinfect, unless using a separate cleaner and disinfectant; and organisms that the product label indicates will be inactivated.
More than 250 active antimicrobial ingredients can be used in formulating surface disinfectants. Some of the common ingredient classifications include halogens, compounds of chlorine, bromine, iodine, phenols, phenolic derivatives, and quaternary ammonium compound derivatives.⁵ Each product's advantages and disadvantages should be considered when selecting the right disinfectant for the task at hand.
Once a disinfectant product is selected, dental professionals should always wear appropriate personal protective equipment when cleaning and disinfecting the treatment area. This includes heavy-duty utility gloves, a gown, eye protection, and a surgical mask (Figure 3). After removing and discarding surface barriers, contact surfaces should be inspected to ensure they were not contaminated during treatment.
Surfaces that pose a risk of contamination should be sanitized with a detergent or disinfectant that contains a detergent. Disinfectant should be applied to the clinical contact surfaces using a fresh towel or EPA-registered disinfectant wipe. Allow the product to remain wet on the surfaces for the full time indicated on the product label. When the manufacturer lists separate times for different organisms, select the longest time listed on the label. Promptly discard the wipe after use. Evidence suggests that using one disinfectant wipe for multiple surfaces can spread contamination between surfaces.⁶
Reduce Environmental Contamination
Reduction of environmental contamination is another effective infection control strategy. Studies show that ultrasonic scalers can spread aerosols to surfaces at least 18 inches away from the source, even when no coolant water is used.^7,8Many organisms can survive for extended periods, as long as several months, on inanimate surfaces.⁹ The concern is that if surfaces are not disinfected, they may serve as a potential source of long-term contamination.⁹
Several strategies have been suggested for reducing the amount of, and distance traveled by, aerosols and spatter generated during ultrasonic instrumentation. The use of high velocity evacuation (HVE) can assist in contamination control. Also, the use of mouthrinses containing antimicrobials such as chlorhexidine gluconate, essential oils, or povidone-iodine, can reduce the microbial count in oral fluids expelled during the use of ultrasonic scalers and other dental devices that produce aerosols and spatter.¹⁰ The CDC does not make recommendations about the use of mouthrinses for aerosol reduction because no connection has been established between their use and preventing disease transmission. Rather, the CDC lists mouthrinses as an unresolved issue in its dental infection control guidelines,¹ either due to insufficient evidence to support a recommendation or no consensus regarding efficacy.
Protecting Nontraditional Care Settings
Increasingly, dental hygiene practitioners are providing care in nontraditional settings such as long-term care facilities, mobile clinics, and homes of housebound patients. These settings can present unique challenges in infection control. The same concepts of standard precautions apply to all settings where health care is delivered. In non clinical settings, the area where care is provided should be isolated by removing unnecessary items and placing the patient in a location with nonabsorbent surfaces that can be disinfected. If this is not possible, impervious barriers should be used to cover all surfaces that may have contact with aerosol and spatter. The same definitions of clinical contact surfaces and housekeeping surfaces apply to these alternative settings.
Infection control for environmental surfaces helps ensure a safe environment for patients and dental professionals. Following the manufacturer's instructions for each product is an important element to success. A breakdown in one step of the disinfection or barrier use procedure can result in accidental cross-contamination. All members of the dental team should be involved in the selection of materials and development of protocols. When new members are introduced to the team, they should receive proper training upon hire. Good communication can help prevent errors and misunderstandings regarding procedures and the proper use of infection control products.

http://www.dimensionsofdentalhygiene.com/ddhright.aspx?id=11575

Puncture brings needlestick safety to the public eye

2012-02-15T07:58:00.000-08:00

Puncture brings needlestick safety to the public eye

By: Medical Environment Update December 7th, 2011 ShareThis

The film Puncture offers a mainstream medium for needlestick safety versus manufacturers and purchasing groups, and is the focus of the December issue of Medical Environment Update.

Here is an excerpt:

Healthcare workers have seen it all when it comes to safety training videos. A throaty narrator gives statistics about workers exposed to dangers if they fail to use safety needles: An estimated 800,000 needlestick injuries occur each year. Workers can be exposed to HBV, HCV, and HIV.

Although these training films routinely make their premiere in healthcare settings, rarely does a motion picture make its way to the big screen, highlighting the issue of needlesticks in the mainstream media.

Puncture, which opened in select cities earlier this fall, does just that, shining a public spotlight on an issue that is generally reserved solely for the eyes of nurses, doctors, and other healthcare professionals. The legal thriller is loosely based on the true story of two lawyers, Michael Weiss (played by Chris Evans) and Paul Danziger (Mark Kassen), who battle medical manufacturing companies when an emergency room nurse contracts HIV after a needlestick, in an effort to determine why safety needles are not being used in healthcare facilities.

“The arc of the story is representing this event where there is the safety needle, but you can’t distribute it in the majority of the healthcare facilities,” says Danziger, an executive producer of the movie, author of the screenplay, and a partner at Danziger & De Llano in Houston. “And the lawyers discover that the reason for that is there are these large group purchasing organizations [GPO] and they control significant portions—up to $100 billion— of what is purchased each year in U.S. healthcare facilities, and they have certain deals with certain manufacturers in order to get kickbacks.”

Danziger says he wrote the movie for two reasons: to honor a friend, Weiss, who passed away, and to expose these issues that seem to fly under the radar in the mainstream media arena.

“I just wanted to get those issues out so that people can discuss it and talk about it and understand it,” Danziger says.

The feature article also includes sections on:

· General public awareness

· Exposing group purchasing organizations (GPO)

· Safety gaps in the healthcare environment

· Whistleblower guidance, including investigation criteria and remedies

· What OSHA says about , GPOs, and safety devices

Also appearing in November issue of Medical Environment Update:

· Vital stats: Hollywood and healthcare hazards

· OMG! OSHA gives GHS to OMB, and three tips for a smooth transition

· Safety officer tip: ‘Tis the season to remind staff about holiday decoration policy rules

· Self-inspection notes: Don’t get fooled; medical evaluations and fit tests are required for respirators

· Q&A on hiding a sharps container in an exam room cabinet; declining and then accepting the hepatitis B vaccination; sharps injury log exemption and bloodborne pathogens training

· A true/false quiz designed to test your understanding of OSHA standards and government regulatory guidelines that apply to healthcare facilities.

http://blogs.hcpro.com/osha/2011/12/puncture-brings-needlestick-safety-to-the-public-eye/?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+OshaHealthcareAdvisor+%28OSHA+Healthcare+Advisor%29

Making Sense of Disinfectant Labels: A Step-By-Step Approach

2011-10-02T06:45:00.000-07:00

Making Sense of Disinfectant Labels: A Step-By-Step Approach

Posted in Articles, Disinfectants, Disinfection & Sterilization, Environmental Hygiene, Association for the Healthcare Environment (AHE)

By J. Hudson Garrett, PhD

Every day, infection preventionists (IPs) and other healthcare personnel face significant challenges due to evolving technology, healthcare reform and, of course, time constraints. Choosing the right disinfectant products must be a carefully made decision but it shouldn’t be burdensome. Yet, because healthcare products are continually being released, updated and retired from the marketplace, IPs would be challenged to monitor the status of every single item within their facilities. This article will provide a methodical approach to evaluate and effectively use healthcare disinfectants including:
• Understanding product labels
• Evaluating broad-spectrum efficacy claims
• Adhering to overall contact time
• Educating staff to improve compliance

Components of Healthcare Disinfectant Labels
In the United States, all surface disinfectants must be registered with the United States Environmental Protection Agency (EPA), the federal government agency responsible for approval of all products containing ingredients with the potential to enter the environment. Once a product is approved by the EPA, the manufacturer will receive an EPA registration number for that specific product. In addition, the EPA assigns an establishment number to the manufacturer and specific locations.

The EPA dictates what information must be included on EPA-registered product labels. For healthcare disinfectant labels, these include the product name, ingredient statement, “Keep Out of Reach of Children” statement, signal words, first aid instructions, net contents/net weight, EPA Registration number, EPA Establishment number, precautionary statements, directions for use information, storage and disposal statement, and any product specific marketing claims and graphics. As you can see, proper interpretation of these labels can sometimes be overwhelming.

Criticality of Broad-Spectrum Efficacy Claims
When evaluating a new or existing healthcare disinfectant, you should review the full listing of efficacy claims available from the product’s manufacturer. It is also important to review other ancillary materials such as the Material Safety Data Sheet (MSDS) and instructions for use documents. Product labels typically list efficacy claims by class of microorganism, including bacteria, viruses, mycobacterium (TB) and fungi.

When evaluating microorganism efficacy claims, review your facility’s infection prevention risk assessment and infection prevention and control plan, as well as the pharmacy antibiogram to ensure proper selection of a product with relevant pathogenic efficacy claims. The broader spectrum a product’s efficacy, the more effective the product will be against a wide variety of gram positive and gram negative bacteria. In addition, with the continual emergence of new and mutations of existing multidrug-resistant organisms (MDROs), IPs should seek products with broad general bactericidal efficacy, but also products that have demonstrated effectiveness against organisms such as multidrug-resistant Acinetobacter baumannii, ESBL-producing organisms such as Escherichia coli, and carbapenem-resistant organisms such as Klebsiella pneumonia. Products with efficacy against these more resistant pathogens will assist the IP in combating the daily threats of these microorganisms.

Viruses, particularly the bloodborne pathogens and those with the potential for causing outbreaks (i.e., norovirus, Influenza and rotavirus) are also of concern to the users of healthcare disinfectants. You should expect (and require) claims against bloodborne pathogens such as HIV, hepatitis B and hepatitis C for any product that will be used in the healthcare environment. Also, seek products with other efficacy claims including enveloped and non-enveloped viruses where appropriate. Note: Products may have different contact times for viruses than for bacteria.
Products effective against mycobacterium are minimally considered intermediate-level disinfectants. (Many clinicians inquire as to why TB is not specifically tested in the laboratory setting for initial product approval. This is due to the high pathogenicity and potential transmission of this organism to the laboratory worker. Rather than put the laboratory workers at risk, a surrogate organism, typically Mycobacterium bovis, is utilized for testing procedures.)
Increasingly more prevalent are fungal organisms being recovered in the healthcare environment such as Candida albicans and Aspergillus. When evaluating fungal efficacy claims, seek products with efficacy against pathogenic fungal organisms that are clinically relevant based on the facility’s risk assessment.

It’s All About the Time: Importance of Overall Contact Time
Manufacturers of disinfectants are required to list detailed information regarding efficacy claims and contact time for each class of microorganism for which the product is effective. This typically includes the classes of bacteria (both Gram-positive and Gram-negative), viruses, mycobacterium and fungi. In accordance with the current requirements from the EPA, labels must also provide detailed information on the product’s effectiveness against bloodborne pathogens including HIV, hepatitis B virus and hepatitis C virus.

Special instructions for cleaning and disinfecting surfaces or other objects potentially contaminated with bloodborne pathogens are simple and easy to interpret. Many manufacturers provide several contact times, most often one for bacteria, one for viruses, another for mycobacterium and possibly one for fungi, as well. These contact times may vary greatly from anywhere from one minute to 10 minutes. Because it is impossible for the user of the product to determine the type of potential contamination that exists on the surface to be treated, the user should disinfect the surface according to the longest contact time found on the product label to ensure full efficacy of the solution is maximized. For example, a healthcare disinfectant that you are reviewing has a contact time for bacteria of one minute, a contact time of two minutes for viruses including HIV, a five-minute contact time for Tuberculosis, and a 10-minute contact time for Fungi, then the total contact time for the product when used correctly is 10 minutes. It is impossible for the user of the disinfectant product to know what microorganisms are present on the environmental surface without using advanced laboratory methods. Hence, the surface should be assumed to be contaminated. Utilizing the longest contact time will ensure that all microorganisms included on the product’s label are successfully inactivated.

The Federal Insecticide, Fungicide and Rodenticide Act (FIFRA) provides for federal control of pesticide distribution, sale and use in the United States. Because healthcare disinfectants are registered with the EPA, consumers can be assured that the products are properly labeled and when used in accordance with the manufacturer’s instructions, the products will not cause unreasonable harm to the environment. The use of the product, however, must be consistent with the directions for use and also any labeling instructions. This is typically found on the product’s label with the following verbiage: “It is a violation of Federal Law to use this product in a manner inconsistent with its labeling.”

Importance of Staff Education
To meet the Joint Commission and other accreditation/regulatory agency requirements, the users of any healthcare disinfectant must be properly trained on the use of the products in accordance with the facility’s policy, as well as the manufacturer’s label and instructions for use. This training should include all relevant indications for use, instructions for use and any relevant safety information. Healthcare facilities should take full advantage of any educational services, including product in-service training, from the product’s manufacturer to ensure that all potential users of the products receive full training to meet regulatory and accreditation requirements and, more importantly, to ensure safe use of the product.

Regulatory and accreditation agencies such as the Centers for Medicare and Medicaid Services (CMS), state departments of public health, and the Joint Commission all assess compliance and proper usage of healthcare disinfectants in healthcare facilities, including hospitals and long-term care facilities. Specifically, surveyors from these agencies solicit feedback from users of healthcare disinfectants regarding proper contact time, efficacy claims and MSDS information.
For more information on the approval process and federal regulations for healthcare disinfectants, visit the Environmental Protection Agency’s website at http://www.epa.gov/oppad001/ad_info.htm/.

When used correctly, healthcare disinfectants assist in maintaining a clean environment in all healthcare settings, both inpatient and outpatient. Regular cleaning and disinfection protocols are critically important in reducing the presence of these pathogens on the high-touch surfaces such as bedrails, over-bed tables, glucose meters, blood pressure cuffs and stethoscopes and prevent cross-transmission. Always be sure to formally evaluate efficacy, safety, labeling instructions, and potential impact on the users of healthcare disinfectants prior to making a decision regarding a potential product.

For specific information disinfection guidelines in healthcare settings, visit the CDC website at www.cdc.gov/hai/.

J. Hudson Garrett Jr., PhD, is director of clinical affairs for PDI Healthcare. He can be reached at hgarrett@pdipdi.com/.

http://www.infectioncontroltoday.com/articles/2011/09/making-sense-of-disinfectant-labels-a-step-by-step-approach.aspx

Declining to use PPE

2011-10-02T06:38:00.000-07:00

Doc – Don’t Allow It!

Declining to use PPE

By: David LaHoda September 30th, 2011

Q: Isn’t it true that OSHA allows healthcare workers to use professional judgment in declining to use personal protective equipment such as gloves and eye goggles?

A: It is true that under the Bloodborne Pathogens standard a worker can decline to use personal protective equipment (PPE), but the circumstances under which this is permitted is limited and cannot be used as a routine practice.

Section 1030(d)(3)(ii) of the standard says that the decision to decline PPE must be:

· Temporary and brief

· Made only under rare and extraordinary circumstances

· Made for reasons that use would prevent the delivery of health care or public safety services or would pose increased hazard to the safety of the worker or co-worker

Enforcement Procedures for the Occupational Exposure to Bloodborne Pathogens provides some examples when declining to use PPE would not be a violation of OSHA standards:

· A sudden change in patient status occurs such as when an apparently stable patient unexpectedly begins to hemorrhage profusely, putting the patient’s life in immediate jeopardy

· A fire fighter rescues an individual who is not breathing from a burning building and discovers that his/her resuscitation equipment is lost/damaged and he/she must administer CPR

· A bleeding suspect unexpectedly attacks a police officer with a knife, threatening the safety of the officer and/or coworkers.

Even when such circumstances occur and judgments are made, the employer is still required to have appropriate PPE available for use, according to the Enforcement Procedures.

http://blogs.hcpro.com/osha/2011/09/ask-the-expert-declining-to-use-ppe/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+OshaHealthcareAdvisor+%28OSHA+Healthcare+Advisor%29&utm_content=Google+Feedfetcher

ADA 2011 LAS VEGAS OCTOBER 9, 10, 11, 12, 13 OnTrack Tracking

2011-10-02T06:34:00.000-07:00

Come to Las Vegas and see OnTrack - the ultimate compliance and quality tracker at Booth 3039
HealthFirst. Fully HIPAA compliant secure tracker for every phase of your office Compliance and Quality Tracking - From training, to calendar alerts, to CEs and total customization.
Do you want to track training, establish and incentive program and track it - it's all there!
Your emergency medications, Blood Borne Pathogens, OSHA, Practice and personnel documentation --
It's all there!

CDA San Francisco Sept 22, 23, 24 HealthFirst Emergency and Compliance Company

2011-08-31T07:58:00.000-07:00

Come to the CDA SF booth 1709 and see the unique Mobile ACLS Emergency Medical Kit
Everything you need for the dental office, home or in the community.
The Mobile ACLS® Emergency Medical Kit allows rapid response to those who need life-saving care, regardless of location. The responder can quickly access a complete set of medications and devices to sustain Basic Life Support, Advanced Cardiac Life Support (ACLS) or Pediatric Advanced Life Support (PALS) for up to 30 minutes. The Mobile ACLS® Emergency Medical Kit also provides medications and devices that are appropriate for a dental office practicing IV sedation.

Also see the new Compliance Products available:
Bloodborne Pathogens Video
Sharps/Med Waste Mailback
Infection Control Chemicals - fastest safest and cleanest

AAMOS Sept. 15, 16, 17 Philadelphia - Banyan's Statkit Z-1000

2011-08-31T07:50:00.000-07:00

Come to AAMOS and see the newsest concept in Emergency Medical Kits at Banyan Booth 539
Banyanʼs Stat Kit Z-1000® Emergency Medical Kit allows rapid response to those who need life-saving care, regardless of location. The responder can quickly access a complete set of medications and devices to sustain Basic Life Support, Advanced Cardiac Life Support (ACLS) or Pediatric Advanced Life Support (PALS) for up to 30 minutes. Stat Kit Z-1000® Emergency Medical Kit helps the medical professional stay compliant and meet the standard-of-care for medical emergencies in the office, at home or in the community.

Intuitive Organization

The Stat Kit Z-1000® organizes its medications and medical devices into sections, compartments and trays –all clearly labeled and categorized into key areas of care. This allows the responder to immediately assess and treat the patient without searching devices and medications.

Mobility for Rapid Response

When seconds can make the difference, recessed polyurethane wheels and a telescoping handle allow the caregiver to respond to the patient –in or out of the office

Durable Construction

The Stat Kit Z-1000® is designed around a strong yet lightweight aircraft-grade aluminum frame, reinforced by heavy-duty water-resistant nylon and internal impact-resistant medication storage trays.

Published Article by Dr. Don | Are Standard Precautions Really Universal?

2011-08-24T16:46:00.000-07:00

Radiation hygiene is critical to providing patient safety.

You wear gloves, sterilize your instruments, and disinfect your work surfaces and use barrier protection. By practicing these and other universal standards, you assume you are keeping your patients and staff as safe as possible in the practice environment.

But what about radiation safety? You provide aprons with thyroid protection, are judicious about taking radiographs only when diagnostically necessary, and use high-speed film or digital sensors. By practicing these standards, recommended by the ADA,¹ CDC, and National Council on Radiation Protection and Measurement (NCRP and state radiation guidelines), again you assume you are doing everything you can to minimize patient and staff exposure to ionizing radiation. However, if you are taking only these steps, you are not enough.

Read Dr. Don's entire article here>

Is dentistry ready for 'the cloud'?

2011-08-24T12:24:00.000-07:00

Is dentistry ready for 'the cloud'?

By Dan Tynan

August 8, 2011 -- Cloud computing may not be taking dentistry by storm just yet, but it is steadily making its way into the world of practice management software and systems. And there are many reasons dental practices should consider investing in it.

"It was a no-brainer that we weren't going to purchase software," said Karah Maloley, who serves as business director for Vail Valley Dental Care. "We didn't even price it. If we were going digital, we thought we might as well go all the way."

So instead of investing thousands of dollars on a dedicated software package, they spend less than $200 a month for Denticon, a Web-based practice management service offered by Planet DDS. Unlike traditional software, Denticon isn't installed on a hard drive inside Dr. Maloley's front office PC. It lives in "the cloud," on Web servers in data centers located across the Internet.

When the Maloleys need to access patient records or schedules, they can log in from virtually any device connected to the Net, whether it's a computer, a smartphone, or a tablet PC. Having their data in the cloud allows the Maloleys to use Planet DDS's Virtual Business Service (VBS), which provides a team of assistants a thousand miles away to handle calls and schedule appointments. In fact, it allowed Karah to work from home after the birth of their first child.

Better access, lower costs

Cloud computing is not merely transforming dentistry, it's also changing how the entire world does business. If you've ever downloaded an email from Hotmail, made a Skype phone call, bought something from Amazon, or checked your bank balance online, you've used cloud computing.

Simply put, the cloud consists of tens of thousands of computers in data centers around the world. Because most of the data processing and storage takes place inside these data centers, you can use smaller and less powerful devices to do the same things that used to require a beefy office PC. All you need is a fast Internet connection.

“The key benefit is that it reduces your IT costs.”— Marty Jablow, DMD

For example, when Dr. Maloley gets an emergency call from a patient, he can look up the patient's records using an app on his iPhone, no matter where he happens to be.

"I want to be accessible to my patients whether they have a dental emergency or just a concern," he said. "This iPhone app lets me have all the patient information immediately when I'm not in the office or at home. I don't have to wait until Monday to find a resolution to their problem."

Cloud computing also offers a dramatic reduction in computing costs. Because cloud-based services can be shared by hundreds or thousands of users at a time, service providers can charge much less per user and still make huge profits. This gives small companies access to the kind of computing power once reserved for big multinationals.

That's why when Adrian Huang, DDS, moved his practice from Arizona to Utah, he went with Curve Dental, another cloud-based practice management service. The cost savings for a small start-up were simply too hard to turn down, Dr. Huang said.

"We wanted to be able to access the system from our computers anywhere, anytime," he said. "Using Curve meant we could start booking patients while our office was still being built and set up all our insurance fee schedules before we even moved in. It's a huge advantage for a start-up to not be forced to open and burn through capital while waiting for construction to be completed."

While Curve's cloud-based dental management service costs slightly less per month than standalone software Dr. Huang has used in the past, he said it saves money in other ways because his office needs less powerful computers.

"We're not really buying the software, we're just buying access to it," he said. "And because all of our data is already online, we don't need to worry about backing it up as much. As a start-up, it felt like we spent less."

In fact, Dr. Huang runs his Ninth East Dental practice almost entirely in the cloud. He uses Gmail for email communications, Google Docs office suite for writing letters and crunching numbers, and QuickBooks Online for accounting. The only thing he really needs an office PC for is storing before-and-after photos for his cosmetic patients, he said -- and even that may soon change.

"We still have patients' photos on our hard drives," he said. "But we're testing a new service from Curve that lets us upload those as well."

Software vendors follow suit

Even patient information systems are moving to the cloud. Patterson Dental Supply recently introduced Caesy Cloud, an Internet-based version of its well-know patient education system. Instead of installing and maintaining a dedicated server in each office, dental pros can subscribe to the service and let patients to watch streaming videos about treatments and procedures on an office PC, laptop, smart phone or even a tablet such as the Apple iPad.

Marty Jablow, DMD, a general practitioner at Green Street Dental in Woodbridge, NJ, and author of the DrBicuspid.com column Ask Marty, has been beta testing the Caesy Cloud system for a couple of months. Using the cloud is a more efficient and less costly way of educating patients, he pointed out.

"Dentists don't have to pay for a server," he said. "There's no setup other than logging in. You don't have to update the service periodically because Patterson will do that automatically. But the key benefit is that it reduces your IT costs."

Of course, moving to the cloud entails some risk. If your Internet connection goes down or your service provider has an outage, you could be unable to process patients. And you must rely on a third party to keep your patient data private and secure.

But Karah Maloley says having the practice's data in the cloud actually makes them feel safer.

"I feel the risks are lessened because our data is stored in the cloud instead of on a computer that can crash," she said. "And if our Internet connection goes down, our extended staff at VBS, who work in a variety of locations, will still be able to access our office information and schedules. There are always concerns about hacking and privacy, but with Planet DDS I feel like I've outsourced these concerns to professionals."

MEDICAL ENVIRONMENT UPDATE—ANNUAL SHARPS EVALUATION

2011-08-24T12:20:00.001-07:00

Medical Environment Update—Annual sharps evaluation

By: Medical Environment Update April 5th, 2011

The April issue of Medical Environment Update takes a close look at the OSHA compliance requirements for the annual review of safety sharps and obtaining worker input on device selection.

Here is an excerpt from that article:

The two sections of the Bloodborne Pathogens standard that make it unique among OSHA regulations also cause a lot of confusion with employers trying to stay in compliance.

Section 1910.1030(c)(1)(iv)(B) necessitates the annual consideration of safety devices when an employer has staff members who are potentially exposed to blood and OPIM, while section 1910.1030(c)(1)(v) requires feedback from nonmanagerial employees on safety device selection.

And many medical practices are clueless about to how to do this, says Kathy Rooker, safety officer and owner of Columbus Healthcare & Safety Consultants in Canal Winchester, OH.

Clueless in compliance
In the course of her mock OSHA inspections, Rooker finds many compliance shortcomings, especially with new clients.

“Practice owners may have purchased some safety devices years ago when they first heard about the Needlestick Safety and Prevention Act, and maybe even use them, but they probably haven’t done anything to stay c ompliant since then,” says Rooker.

Either managers never learned about the annual updating as part of the exposure control plan, or they have conveniently forgotten it, says Rooker. Meanwhile, staff assume it’s okay for the nurse manager or head medical assistant to pick and choose what safety devices will be used in the practice. Employees don’t even know that OSHA wants them to have a say in safety device selection.

There are a lot of safety devices for a wide range of procedures that can eliminate or significantly reduce the potential for needlestick and sharps injuries, says Rooker, and safety device manufacturers and distributor representatives can help you sort out the selection process to keep your staff members safe and your practice in OSHA’s good graces.

http://blogs.hcpro.com/osha/2011/04/medical-environment-april-2/

Dental Safety Officer Tip: Rules For Extracted Teeth

2011-08-02T07:55:00.000-07:00

Dental safety officer tip: OSHA rules for extracted teeth

By: Medical Environment Update August 2nd, 2011

A question the Medical Environment OSHA consultation hotline often gets is: What to do when a patient asks for his or her extracted teeth?

In this matter, the CDC’s extracted teeth section of the Guidelines for Infection Control in Dental Health-Care Settings provides useful advice.

“Extracted teeth may be returned to the patients upon request and are not subject to the provisions of the OSHA Bloodborne Pathogens standard,” according to the FAQ section of the guidelines.

Remember, OSHA regulates safety involving employer-employee relations, not patient safety.

However, disposing of extracted teeth is an OSHA concern. Disposal of extracted teeth must follow the containerization and labeling requirements of regulated medical waste as the standards instruct, according to the CDC Guidelines.

Do not place teeth containing amalgam, however, in containers that use an incineration process, advises the CDC. For that situation, check with state and local regulations concerning amalgam disposal.

The CDC also advises on the safe use of extracted teeth in educational settings. For this setting, remove visible blood and gross debris and maintain in a hydrated state. Then autoclave the teeth before the teaching exercise.

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Survey Reveals High Rate of Noncompliance with PPE Protocols

2011-08-02T07:42:00.001-07:00

Survey Reveals High Rate of Noncompliance with PPE Protocols

In a survey released by Kimberly-Clark Professional, 89 percent of safety professionals said they had observed workers not wearing safety equipment when they should have been. Twenty-nine percent said this had happened on numerous occasions.

"This high rate of noncompliance with PPE protocols presents a serious threat to worker health and safety," says Gina Tsiropoulos, manufacturing segment marketing manager for Kimberly-Clark Professional. "While the reasons for noncompliance are varied, the threat to workers is clear-cut. Without the proper use of PPE, they are at risk of serious injury or even death."

The Occupational Safety & Health Administration (OSHA) requires the use of personal protective equipment to reduce employee exposure to hazards when engineering and administrative controls are not feasible or effective. Yet, data from the Bureau of Labor Statistics (BLS) show that of the workers who sustained a variety of on-the-job injuries, the vast majority were not wearing PPE. It is therefore no surprise that 78 percent of respondents said workplace accidents and injuries were the concerns most likely to keep them up at night.

Worker compliance with safety protocols was also cited as the top workplace safety issue. Twenty-eight percent of respondents chose this, while 21 percent selected "fewer workers." "Insufficient management support for health and safety functions" and "meeting the safety needs of an aging workforce" tied at 18 percent. Lack of funds to implement safety programs was last at 8 percent.

Given the importance of PPE in ensuring worker safety, the survey examined the reasons for such high levels of noncompliance. Of those respondents who observed PPE noncompliance in the workplace, 69 percent said the primary cause was workers thinking that PPE wasn't needed. This was followed by:

- Uncomfortable

- Too hot

- Poor fit

- Not available near work task

- Unattractive-looking

The Future of Workplace Safety

What measures have safety managers taken or plan to take in the near future to encourage greater PPE compliance? The top strategies were: improving existing education and training programs (61 percent) and increased monitoring of employees (48 percent). These were followed by:

- Purchasing more comfortable PPE

- Tying compliance to individual performance evaluations

- Purchasing more stylish PPE

- Developing incentive programs

Most Challenging PPE

When it comes to compliance with PPE protocols, eye protection was found to be the "most challenging" PPE category, according to 24 percent of respondents. This was a disturbing though not unexpected finding considering that nearly three out of five workers who experienced eye injuries were found not to be wearing eye protection at the time of the accident or were wearing the wrong kind of eye protection for the job.(1) Add to this the fact that that thousands of workers are blinded each year from work-related eye injuries that could have been prevented(2) and the magnitude of the problem becomes clear.

The next highest category for noncompliance was hearing protection (18 percent) – another disturbing finding since occupational noise-induced hearing loss is 100 percent preventable when proper measures are implemented. It was followed by respiratory protection/masks (17 percent), protective apparel (16 percent), gloves (14 percent), and head protection (4 percent).

Choosing and using surface disinfectants

2011-07-20T07:55:00.001-07:00

Choosing and using surface disinfectants

From RDH http://www.rdhmag.com/index/display/article-display/8373153520/articles/rdh/volume-31/issue-6/columns/choosing-and-using-surface-disinfectants.html

by Noel Kelsch, RDHAPn.kelsch@sbcglobal.net

One of my favorite things to bake is homemade rolls. There is nothing like the feel of dough in my hands, or the aroma that fills my house when I have a batch baking in the oven.

Recently, I sent my husband to the store for some flour so that I could grant him his single wish of a tray filled with "Slap Your Mama" rolls. When he returned, I realized he had not heard a word I said. He came home with the cheapest flour on the shelf, not the "better for bread" flour I had requested. The choice he made would directly affect what I was trying to accomplish. This flour did not contain the amount of protein that science has proven is needed to create the gluten air-filled sacks that make bread light and airy.

Choosing and using a surface disinfectant in dentistry is much like shopping for and using flour.

In 2003, the Guidelines for Infection Control in Dental Health-Care Settings gave us all science-based information that told us we should clean and disinfect clinical contact surfaces that are not barrier-protected by using an EPA registered hospital grade disinfectant with low- (such as HIV and HBV label claims) to intermediate-level (such as tuberculocidal claim) activity after each patient. Use an intermediate-level disinfectant if visibly contaminated with blood.

Clinical contact surfaces: Surfaces that are touched by contaminated hands, instruments, devices, gloves, etc. They include light handles, switches, radiograph equipment, dental chairside computers, reusable containers of dental materials, drawer handles, faucet handles, countertops, pens, telephones, and doorknobs.1
Cleaning: Removing visible contamination from a device or surface.
Disinfection: Destruction of pathogenic and other kinds of microorganisms by physical or chemical means.2

The preceding directives give us great information. Other points to remember include:

? We have to clean and then disinfect. This is a two-step process. We must first clean off the debris and then disinfect the surface. Those are two separate steps. For example, in following label directions for using disposable towels that are premoistened, you would use one to clean the contact surface and then throw it away. You would get a fresh towel and use it to disinfect the contact surface. Following directions on the package ensure compliance with the science-based experiment that was conducted in developing use of this product.

? EPA-registered, hospital grade disinfectant is not just something you pick up off the shelf at a local store. It must have an EPA registration number and state that it is a hospital grade disinfectant.

? Barrier protection is a very effective method of preventing cross-contamination. If the area is difficult to clean, barrier protection should be utilized. If barrier protected surfaces are contaminated during treatment or when removing barrier protection, they should be cleaned and disinfected.

? You must use an intermediate-level disinfectant if the area is visibly contaminated with blood.

In choosing and using a surface disinfectant, you need to keep several things in mind:

? Is it safe for the surface I am going to use it on? An office recently shared with me that they had switched to a product and suddenly the threads on their chairs were falling apart. They read the label and soon discovered this hospital grade disinfectant was not intended for use on cloth and had destroyed the thread quickly. Manufacturers of dental devices and equipment should provide information regarding materials compatibility with liquid chemical germicides, whether equipment can be safely immersed for cleaning, and how it should be decontaminated if servicing is required.1

? What personal protective equipment do I need to wear in order to use this product? Both the direction label and the material safety data sheet (MSDS) will tell what you need to wear while using this product. Because of the risks involved with working with chemicals and contaminated surfaces, gowns, masks, eye protection, and chemical- and puncture-resistant utility gloves are a must. Many products can break down latex based gloves exposing clinicians to chemicals that are toxic. Chemical and puncture resistant utility gloves should be utilized during this task.

? How safe is it for me to work with? It is important to note if any staff members are allergic to ingredients or if any of the ingredients have side effects in the method with which it will be used.

? How long can I be exposed to this product? The MSDS will give you the time-weighted average (TWA) for the product and any cautions for length of time of use. It is important that all office members who are using a product are trained in the TWA and MSDS. All tasks need to be delegated so no one is over-exposed.

? What is the shelf life of this product? If the product has a short shelf life, it is important that you are tracking it and replacing it when necessary. Short shelf lives may mean wasted products. Many products require special handling for disposal.

? Do I have to mix this myself? Sometimes just having the time to mix and formulate a product can be very confusing and time consuming. Keeping products simple and easy to use can eliminate the chances for mistakes being made.

? Am I using this for intermediate or low level? Low level targets HIV and HBV label claims, and intermediate level targets tuberculocidal claims. Remember, if there is visible blood, you must use intermediate level.

? How easy is it for me to work with? Some products both clean and disinfect, saving you the time of switching back and forth from one product to another. Some are premixed and ready to use. Check to see if the product is is complex or simple to use, if instructions are included, and if the intended use can be accomplished in your setting.

? Is the wait time realistic? Not very many of us have 15 minutes between patients. Yet there are disinfectants that require that amount of time. Time yourself and see how much time you have between patients and match the product to that time.

The Organization for Safety, Asepsis and Prevention (OSAP) is a nonprofit organization. OSAP is a unique group of dental educators, consultants, researchers, clinicians, industry representatives, and others with a collective mission to be the world's leading advocate for the safe and infection-free delivery of oral care. OSAP supports this commitment to dental workers and the public through quality education and information dissemination.

Your membership in this organization will assure you access to the most current and valuable information you will need in your daily clinical practice to keep you and your patients safe. Membership is an inexpensive investment that includes all compliance issues being addressed in one place!

Check out their website at www.osap.org. I love the "Ask OSAP" section; it has all of the questions you are facing in clinical practice with the science-based answers! The association also maintains a list of EPA-registered, hospital grade disinfectants at www.osap.org/page/SurfDisinfec2010.

Choosing and using a surface disinfectant in dentistry is much like shopping for and using flour. My husband finally got his "Slap Your Mama" rolls after a second trip to the store to get the product that was developed for this purpose. As you make choices with surface disinfectants, I hope that you will use your clinical reasoning skills and science-based information to keep patients and yourself safe.

References

Guidelines for Infection Control in Dental Health-Care Settings 2003
From Policy to Practice, OSAP's Guide to the Guidelines, 2003

What Makes Teeth Chatter

2011-07-12T14:09:00.001-07:00

What Makes Teeth Chatter

By C. CLAIBORNE RAY New York Times

July 12, 2011

Q. What might cause teeth to chatter other than the cold?

A. There are several kinds of involuntary jaw movements, said Dr. Steven Syrop, section chief of temporomandibular disorders at NewYork-Presbyterian Hospital/Columbia University Medical Center, and it is important to distinguish chattering from grinding and from still another problem, called oromandibular dystonia. “Teeth chattering is usually related to shivering, which is the body’s response to cold,” Dr. Syrop said, but it can also result from an infection causing chills.

Teeth grinding, or bruxism, is thought to be a habit aggravated by stress, he said. The exact cause is not known, but recent evidence has de-emphasized the role of occlusion, or the way the upper and lower teeth come together. “Different from this is when the jaw muscles contract and relax spontaneously, producing constant jaw movement,” Dr. Syrop said. “This is called oromandibular dystonia.” This kind of motion can be the result of several different medical conditions, including reaction to certain medications.

According to the Dystonia Medical Research Foundation, oromandibular dystonia is one of more than a dozen kinds of dystonia, in which the neurological mechanism that makes muscles relax when they are not in use does not function properly. The contractions can interfere with chewing and swallowing.

Treatment

Eye Wash Station Checklist

2011-07-06T07:40:00.001-07:00

Eyewash station weekly checklist

By: Medical Environment Update July 5th, 2011

Here is a tip from the July issue of Medical Environment Update, which featured OSHA compliance and emergency eyewash stations in medical and dental practices.

Plumbed eyewash stations require weekly checks to be compliant with ANSI Z358.1-2009, which OSHA may reference during an inspection. Each week, check for the following:

1. Access and signage. Eyewash stations must be easily identifiable and unobstructed.

2. Operation. Turn on the station and check that:
— The station activates easily with foot or one-handed control
— The flow removes eyepiece covers
— Water flows evenly in a steady stream from both eyepieces

3. Flush. Run the station for three minutes to flush stagnant water from the line.

4. Eyepiece cover disinfection. Rinse covers according to manufacturers’ instructions or with 10% bleach solution. Flush with water for 15 seconds, then replace.

Protecting yourself from tuberculosis exposure

2011-07-06T07:37:00.001-07:00

Protecting yourself from tuberculosis exposure

Mary Govoni, CDA, RDA, RDH, MBA

For more on this topic, go to www.dentaleconomics.com and search using the following key words: infection prevention, tuberculosis exposure, reasonable accommodations, Mary Govoni.

Although the number of new cases of tuberculosis has been steadily declining in the United States for the last several years, treating patients with TB in dental facilities can pose a risk of infection to dental professionals. Both the CDC and OSHA recommend that dental practices have protocols in place for protecting employees from TB exposure. These protocols include withholding elective treatment from patients who have active TB infections.

In addition, treatment should also be withheld — at least temporarily — from patients who show possible signs of TB infection. These signs include a prolonged cough of three to four weeks or longer, coughing up blood, fever of unknown origin, fatigue or malaise, night sweats, and unexplained weight loss. These symptoms may also indicate other serious health problems for a patient. So, in any case, it would be a good idea to send a symptomatic patient for a medical consult prior to any elective treatment. Elective treatment is defined as routine, nonemergency services (prophylaxis, restorations, etc.).

The Americans with Disabilities Act prevents dentists from withholding treatment from patients with HIV/AIDS. Tuberculosis is different, however, in that the modifications that would have to be made to a dental facility to perform routine treatment on patients with active TB would be beyond the scope of “reasonable accommodations” in the act.

Initial steps in minimizing the risk of exposure to tuberculosis are to review patient medical history forms and make certain that patients are asked questions about TB, such as history and also the symptoms described previously.

Next is to perform a community risk assessment to determine the number of TB cases in the geographic area in which the practice is located. This can easily be done online through state health department websites. Most state health departments publish disease statistics by county, including TB. This information should be documented annually in the office OSHA/safety manual.

If a patient presents with possible symptoms of TB and/or a positive medical history, the dentist should refer the patient for medical screening before providing anything but emergency treatment for that patient. Keep in mind that patients may have TB, but have been in treatment for a long enough period to be classified as nonactive or noninfectious.

If a physician or health department official documents the patient’s status as such, it is safe to perform elective treatment. Some patients may have been exposed to TB and may be taking prophylactic antibiotics to prevent an infection. It is safe to treat these patients as well, but only after documentation from a physician.

A dentist is not obligated to treat new patients who indicate that they have active TB. But if a patient of record presents for emergency treatment, it is up to the dentist to determine whether to treat the patient in the office.

For minor emergencies, such as a crown that needs to be recemented or a fractured tooth that needs to be temporized, those procedures can be easily completed in the office provided that the clinical team wears the appropriate respiratory protection or face mask. This is an N-95 particulate respirator. This type of mask is approved by the National Institute for Occupational Safety and Health (NIOSH) for protection against tuberculosis and influenza. It is a good idea to have these masks on hand in case they are needed for treating a patient with TB.

Other precautions that should be taken are minimizing the creation of aerosols during treatment. Isolating with a dental dam if appropriate is one of the best methods.

If use of a dam is not appropriate, having the patient use a preprocedural mouth rinse with chlorhexidine is another effective way to reduce the microbes introduced into the air during treatment. Using high volume evacuation helps as well. Ultrasonic scalers should never be used to treat patients with active or suspected tuberculosis infections.

Remember that screening your patients for tuberculosis and symptoms of TB is an important part of the infection prevention program for your practice.

Author’s clarification: In a previous column on instrument sterilization, I was not clear on the types of indicators inside of sterilization pouches. There are some pouches that have a temperature-only indicator inside the pouch, while others have indicators that measure all three parameters for sterilization — time, temperature, and pressure. I recommend that pouches with the three-parameter indicators be used. Check with the manufacturers of the pouches you use to make sure that they are the type that meet those criteria.

Mary Govoni, CDA, RDA, RDH, MBA, is the owner of Clinical Dynamics, a consulting company based in Michigan. She is a member of the Organization for Safety, Asepsis and Prevention. She can be contacted at mary@marygovoni.com.

Awareness: H.I.V. Campaign Finds 18,000 New Cases

2011-06-29T10:43:00.000-07:00

Dentists have the perfect opportunity to contribute here via Rapid Oral HIV Testing

From The NY TIMES

Vital Signs

Awareness: H.I.V. Campaign Finds 18,000 New Cases

By RONI CARYN RABIN

Published: June 27, 2011

A three-year campaign intended to expand testing for H.I.V. and get people into treatment turned up more than 18,000 adults who were not aware that they were infected, the federal Centers for Disease Control and Prevention reported last week.

Over all, some 2.7 million H.I.V. tests were performed between October 2007 and September 2010. Just over 1 percent of those tested, or 29,503, were found to be infected. Of those, 18,432 were not aware of their status, C.D.C. officials said.

Some 12,711 of those for whom the diagnosis was new, or about 75 percent, were routed into the health care system.
The drive, which targeted at-risk populations and blacks in particular, included $111 million provided to 25 health departments serving communities disproportionately affected by H.I.V. Men accounted for 72 percent of the new H.I.V. diagnoses, and blacks accounted for a similar percentage.
An estimated 240,000 Americans — a fifth of the nearly 1.2 million living with H.I.V. — do not know they are infected, said Dr. Kevin Fenton, director of the C.D.C.’s AIDS prevention center.
“The majority of the estimated 56,000 new H.I.V. infections that occur each year are transmitted by those who are unaware of their infection,” he said.

'Glowing Hands' Gel Shows Kids Where Dirt, Germs Linger

2011-06-21T08:30:00.000-07:00

This might be interesting to try in your own office?

'Glowing Hands' Gel Shows Kids Where Dirt, Germs Linger

It helped improve children's handwashing techniques, study says

-- Mary Elizabeth Dallas From Health Day

FRIDAY, June 17 (HealthDay News) -- Use of a glowing gel that reveals microscopic germs on the skin may help children improve their hand hygiene, according to new research.

The researchers said their findings, published in the June issue of Infection Control and Hospital Epidemiology, could have a lasting impact on efforts to reduce the spread of communicable disease.

"We found that using the gel alone to illustrate the areas of hands that may not be getting clean, even without verbal education, improves children's hand hygiene," said the study's principal investigator, Dr. Mary Groll of Northwestern University Children's Memorial Hospital in Chicago, in a journal news release.

For the study, researchers asked 60 children waiting in an emergency room to apply Glo Germ Gel to their hands. The kids then placed their hands under a black light, which highlighted any dirt or bacteria with a yellow glow. Next, the children were asked to wash their hands with soap and water before placing them back under the black light. Based on the before and after results, researchers scored the kids' hand hygiene.

"Waiting for the doctor is usually a tiresome and unproductive experience, but we were able to turn the waiting room into an interactive education center to help kids improve their hand hygiene," said the study's lead author, Dr. Anna Fishbein, a physician and researcher at Children's Memorial Hospital in the news release.

Following the test, about half the children received a brief lesson in proper hand-washing techniques, such as washing for at least 20 seconds, cleaning between fingers and washing finger nails. The other children received no additional education.

Two to four weeks later, about three-quarters of the original participants returned to have their hand washing re-evaluated. Every child who followed up scored significantly higher on the hygiene scale, regardless of whether they received extra instruction on how to wash their hands.

"Considering the importance of hand hygiene in disease prevention, the implications of this study will have lasting impact in this community's effort to decrease the spread of illness," Groll said.

OSHA ADVISES ON PROTECTING TEEN WORKERS

2011-06-21T08:21:00.000-07:00

OSHA advises on protecting teen workers

By: David LaHoda June 21st, 2011

An item in the June 15 OSHA QuickTakes reminds employers that OSHA standards afford protection to temporary summer employees, many of whom may not know about their rights under OSHA.

OSHA resources that both young workers and employers should know about include:

· A bookmark explaining young workers’ rights

· Web pages detailing young workers’ rights, work hour restrictions, and prohibited jobs

· Hazards related to common summer jobs

All of the items above can be accessed thorough OSHA’s Young Workers online resource which also includes sections for employers, parents, and educators.

Don't Drink And Sanitize Your Hands?

2011-06-09T08:08:00.000-07:00

Expert Studies Hand Sanitizer's Effect on Alcohol Screenings

Posted in News, Hand Sanitizer, Hand Hygiene, Research, Research & Studies

Gary Reisfield, MD, an assistant professor in the department of psychiatry with the UF College of Medicine.

Continued use of an alcohol-based hand sanitizer every few minutes could trigger a positive screen for alcohol use in certain types of tests, a University of Florida study confirms. However, UF researchers also discovered a potential biomarker that could allow tests to differentiate between drinking alcohol and exposure to hand sanitizers and other household products, according to Gary Reisfield, MD, an assistant professor in the department of psychiatry with the UF College of Medicine.

The findings, published in the Journal of Analytical Toxicology in March, are particularly significant for people who use hand sanitizers frequently, such as health professionals. For individuals working in these fields who are in substance abuse programs or required to be tested frequently for alcohol use, chronic use of alcohol-based sanitizers could lead to false positives.

“Many of the hand sanitizers contain ethyl alcohol, which is the same type of alcohol in alcoholic beverages,” says Reisfield, chief of pain management services in the division of addiction medicine. “The body does not distinguish between drinking alcohol and handwash alcohol. Anyone out there who is required to abstain from alcohol needs to be very cognizant about alcohol that may be hidden in products such as handwashing gels, mouthwashes, hairsprays and cosmetics,” he adds. “You need to be careful not just what you put in your body but what you put on your body.”

Reisfield adds, “Alcohol is a legal drug, so for individuals who are not required to abstain from alcohol, the presence of EtG and EtS in the urine is of no consequence. Impairment is the issue for healthcare workers, individuals operating motor vehicles, etc. Impairment is determined by blood alcohol levels and – by proxy – breath. It is not determined by urinary biomarkers of past-several-day use.”

Although blood and breath tests are more commonly used to detect the presence of alcohol in the bloodstream, they only detect what a person drank recently, Reisfield says. Another type of test, called an EtG, measures the level of substances left behind after alcohol is metabolized and can detect use over a longer period of time. The UF study looked at these types of tests, which measure the levels of ethyl glucuronide and ethyl sulfate in urine as indicators of alcohol use.

The investigators examined 11 subjects with no history of alcohol use, looking to see how frequent use of hand sanitizer affected the levels of these substances in their urine. Study participants used hand sanitizer every five minutes for a 10-hour period for three days in a row, which Reisfield says is similar to what nurses are exposed to while on duty. Their urine was tested at the end of each day and before the start of a new day.

“What we found was nearly all the individuals produced alcohol metabolites consistent with drinking alcohol,” Reisfield says.

When comparing the levels of ethyl glucuronide and ethyl sulfate in the urine of people who used a lot of sanitizer with people who drank alcohol, the researchers also noticed that the level of ethyl sulfate was much lower in the sanitizer group, not coming close to the cutoffs used to indicate alcohol use.

Reisfield says looking at ethyl sulfate could help laboratories more accurately pinpoint alcohol use. “We will be looking at this further in subsequent studies,” he says. “Ethyl sulfate may be a critical biomarker that has not been looked at in great detail. It may help distinguish between the exposures. We really cannot tolerate false positives. Falsely accusing someone of alcohol abuse can have potentially devastating effects personally and occupationally.”

Reisfield says he and his colleagues submitted an additional communication to the Journal of Analytical Toxicology “to pre-empt objections that ethanol metabolites in urine might actually result from inhalation of the sanitizer vapor rather than transdermal uptake. We believe that the latter mechanism is the major route of the ethanol absorption that leads to EtG and EtS in urine. In the next phase of our study, we will have non-handwashers in the room among the study subjects in order to prove this point.”

Reisfield and his colleagues followed up the original study with a letter to the editor of the Journal of Analytical Toxicology (“Respiratory Exposure to Ethanol Vapor During Use of Hand Sanitizers: Is It Significant?” Vol. 35, No. 5, June 2011. Pages 319-320) in which they explained, “We recently reported urinary ethyl glucuronide (EtG) and ethyl sulfate (EtS) concentrations in subjects intensively exposed to an ethanol-containing hand sanitizer under a controlled research protocol. We concluded that dermal exposure to ethanol can result in urinary EtG concentrations exceeding commonly accepted thresholds for substance abuse recovery programs that require abstinence from ethanol use. In our report, we acknowledged that inhalation of vaporized ethanol during use of the hand sanitizer may contribute to absorption; however, the experiment was not designed to assess the relative contributions of dermal versus respiratory ethanol exposure. An unpublished study by Gregory E. Skipper and colleagues suggested that inhalation was the primary mechanism by which ethanol is absorbed when using ethanol-containing hand sanitizers, and when this study was brought to our attention, we re-evaluated the potential that our study design may have overestimated the exposure to ethanol because of accumulation of ethanol vapor in the study environment.”

Reisfield clarifies, “The level of transdermal (and respiratory) alcohol uptake, even by liberal users of alcohol-based hand sanitizers poses no known health risks. Glucuronidation is a detoxification mechanism – a means of helping the body eliminate drugs. Moreover, only about 1 percent of an alcohol dose is converted to EtG or EtS metabolites. There are some individuals who believe that most of the alcohol uptake from hand sanitizer use results from respiratory uptake. Our group, as you know from our letter, believes that most of the alcohol uptake is transdermal, but there are currently no studies that we are aware of that quantitate the relative contributions of respiratory and transdermal uptake. We believe that it actually doesn’t matter much unless a monitored, alcohol-dependent, healthcare worker is cloistered in a closet and exposed to alcohol hand sanitizer all day. But, as I mentioned previously, we will control for respiratory uptake in our next study.”

Source: Compiled from the UF Health Science Center news item, “Germ-killing sanitizers could have effect on alcohol tests” by April Frawley Birdwell, and email interview with Gary Reisfield.

http://www.infectioncontroltoday.com/news/2011/06/expert-studies-hand-sanitizers-effect-on-alcohol-screenings.aspx

OSHA UPDATES ENFORCEMENT GUIDELINES ON PPE COMPLIANCE

2011-06-09T08:06:00.000-07:00

Medical Environment Update, June 2011—OSHA updates enforcement guidelines on PPE compliance

By: Medical Environment Update June 8th, 2011

The June issue of Medical Environment Update takes a close look at OSHA’s new directive that clarifies PPE training requirements for general industries, including healthcare.

Here is an excerpt from that article:

At the beginning of February, OSHA released a directive updating enforcement guidelines for PPE for general industries.

Few industries rely more heavily on effective PPE than healthcare, and much of that PPE’s effectiveness depends on suitable training to ensure that staff are using the equipment appropriately.

The new directive gives OSHA inspectors updated guidance on when and why to cite facilities that aren’t in compliance with PPE requirements. It also gives safety officers some guidance as to which violations will earn them a citation and specifics on how to appropriately train frontline staff members.

Significant changes from the old enforcement guide (which was last updated in 1995) include:

· What type of PPE employers must provide at no cost, when employers must pay for PPE or for replacement PPE and when employers are not required to pay for PPE

· Payment requirements for PPE worn off the job site, for PPE that must remain at the job site, and for employee-owned PPE

· Enforcement policies that reflect court and review commission decisions concerning PPE

· Guidance allowing employers to use PPE constructed in accordance with the most recent national consensus standards

Documented OSHA guidelines such as these are particularly helpful to safety officers because they help define what an OSHA official will look for during an inspection, says Bruce Cunha, RN, Ms, COHN-S, manager of employee health and safety at Marshfield (WI) Clinic. “Overall, it’s a good way to give you a good checklist on what you need to be doing,” Cunha says.“One of the nice things about the enforcement guides is you can really read through it and say, ‘How is our program when we compare it to the enforcement guides, not just to the standards itself?’”

The feature article includes:

· How is healthcare affected?

· Providing appropriate training

· Training suggestions

· Compliance problem areas with PPE

· What PPE does your facility have to pay for?

http://blogs.hcpro.com/osha/2011/06/medical-environment-update-june-2011%e2%80%94osha-updates-enforcement-guidelines-on-ppe-compliance/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+OshaHealthcareAdvisor+%28OSHA+Healthcare+Advisor%29&utm_content=Google+Feedfetcher

.Breaches Lead to Push to Protect Medical Data

2011-06-01T17:11:00.000-07:00

From The New York Times 6/1/2011

Federal health officials call it the Wall of Shame. It’s a government Web page that lists nearly 300 hospitals, doctors and insurance companies that have reported significant breaches of medical privacy in the last couple of years.

So the administration is making new efforts to enforce existing rules about medical privacy and security. But some health care experts wonder if the current rules are enough or whether stronger laws are needed, for example making it a crime for someone to use information obtained improperly.

For the full content
http://www.nytimes.com/2011/05/31/business/31privacy.html?emc=eta1

Survey shows worldwide noncompliance for hand hygiene

2011-06-01T16:39:00.000-07:00

Survey shows worldwide noncompliance for hand hygiene

By: Erica Jordan May 31st, 2011

A survey distributed globally by the World Health Organization (WHO) found that nearly 50% of healthcare professionals don’t wash their hands before coming in contact with patients. This crucial step is WHO’s Moment 1 in its initiative, Save Lives: Clean Your Hands (SLCYH), which has five recommendations (moments) for healthcare workers. The steps say healthcare providers should perform hand hygiene:

Before touching a patient
Before clean/aseptic procedures
After body fluid exposure/risk
After touching a patient
After touching patient surroundings

The survey data came from 327 healthcare facilities registered with the SLCYH initiative, reports Medscape. The data showed compliance with the first moment of hand hygiene was just 51.4% globally. Of those who performed hand hygiene, 60.7% practiced hand rubbing, 37.6% practiced hand-washing, and 1.7% practiced both .
The data also found that European countries had the highest hand hygiene compliance for moment 1, at 64% of 22,278 opportunities, while the America’s had the lowest at 26% of 23,183 opportunities.

YOU DON'T HAVE AN EMERGENCY PLAN?

2011-05-25T07:36:00.000-07:00

Great article by Kathy Rooker:

Notes from the field: You don’t have an emergency action plan?

By: Kathy Rooker May 25th, 2011

Sometimes medical offices are so focused on workplace hazards like bloodborne pathogens that they forget about other areas of OSHA compliance.
Recently as I was doing one of my mock OSHA inspections, I asked the manager if I could see the office’s emergency action plan (EAP). She had no clue what I was talking about.
Employees need to know how to handle any type of an emergency that may arise, according to OSHA’s Emergency Action Plans standard, and if you have 11 or more employees, the plan must be in writing.
As I was trying to explain what details needed to be included in this plan, the manager jokingly said: “If something happens, I’m outta here.”
I told her she really needed to take this seriously. What if there is a tornado? Where are the employees and patients going to go to seek safety from the storm? Have the employees been trained on evacuation procedures if there is a fire in the building? I asked the manager if she had trained the staff on how to use a fire extinguisher if required as part of their job duties, and she finally realized that she needed help with preparing and training her staff on handling emergencies and evacuations.
Your EAP should include policies and procedures for bomb threats, fires, extreme weather conditions, medical crises, and workplace violence. Take each situation and document how to safely and efficiently handle it. For example, conduct a fire drill and assess how quickly the staff evacuated the building. Did everyone go to the specified location? Did they remember not to use the elevator? How long did it take to get everyone out of the building? If it took 10 minutes, you may want to repeat the fire drill.
Train the staff and physicians on how to handle emergencies that are likely to happen given the nature of your practice and its location. Review this plan with all new employees and whenever the plan has been updated.
The goal is to avoid panic and frustration during an emergency.

Some Soap Dispensers May Contribute To Contamination

2011-05-09T09:50:00.001-07:00

Study finds some refillable soap dispensers may contribute to contamination

By: Erica Jordan May 5th, 2011

A study published in the May issue of Applied and Environmental Microbiology found that washing hands with soap from bulk-soap-refillable dispensers, like those seen in public restrooms, may put people at risk for increased bacteria transmission.

Researchers wanted to calculate hand contamination and transfer of bacteria after the use of contaminated soap. To do this, researchers used liquid soap that they contaminated, reports the study. Bacteria was transferred from the soap to hands.

The researchers found an increase in bacteria on people’s hands after they washed with contaminated soap from the bulk-soap-refillable dispenser. By washing hands with soap from sealed refill dispensers, bacteria was reduced.

Researchers concluded that bacteria transmission in public places can result from using contaminated soap from bulk-soap-refillable dispensers.

Latex Gloves Banned?

2011-04-27T10:35:00.000-07:00

Surgical and patient examination gloves that have cornstarch powder on them or are made of natural rubber latex should be banned because of the serious threat they pose to patients and healthcare workers, said the group Public Citizen in a petition filed late Monday with the Food and Drug Administration (FDA). Further, safer alternatives, such as powder-free, non-latex gloves, are readily available.

For healthcare workers, the major risk posed by the gloves is allergic reactions to latex, some of which can be serious or life-threatening. These allergic reactions can occur when healthcare workers wear latex gloves or when they inhale cornstarch powder bound to latex proteins that has been released from latex gloves worn by others. Breathing in cornstarch powder bound to latex proteins can cause acute asthma attacks and anaphylactic shock in healthcare workers sensitized to latex.

http://www.infectioncontroltoday.com/news/2011/04/group-tells-fda-that-latex-medical-gloves-should-be-banned.aspx

From The NYTimes: Medication Related Injuries On The Rise

2011-04-20T07:43:00.000-07:00

Here's a sobering statistic: in 2008, 1.9 million people became ill or injured from medication side effects or because they took or were given the wrong type or dose of medication, compared with 1.2 million injured in 2004, this was according to the Agency for Healthcare Research and Quality.
As our patients age and take more and more medications, it is imperative that we know each side effect, cross reaction and drug interaction of every drug that we use or prescribe.
Whether we use the PDR or cloud based programs like Lexicomp, we must verify the safety or the drugs we use and prescribe.

http://well.blogs.nytimes.com/2011/04/14/medication-related-injuries-on-the-rise/?partner=rss&emc=rss

New Jersey 49 of 91 Surgicenters Fail On Infection Control

2011-04-18T08:14:00.000-07:00

New Jersey 49 of 91 Surgicenters Fail On Infection Control - could your office pass?
Here is a brief (incomplete) check list - see how you do.

1. Spore or biological test each autoclave at least weekly
2. Utilize a surface disinfectant to the full manufacturer's instructions
3. Everyone wears proper PPE for ALL procedures
4. Use nitrile utility gloves after each patient for housekeeping
5. Change every barrier between each patient including x-ray head and discharge button barriers
6. Autoclave each handpiece (high or slow speed ) after each use
7. Barrier protect the Ultrasonic scaler handpiece and change for each patient
8. Every person with BBP exposure has received annual OSHA Mandated Training
9. Barrier protect each keyboard and mouse in each operatory
10. Store all burs and diamonds in drawers not on counters

This is a very brief list. If you answered yes to all 10 you are in the right direction on infection control. Keep it up!!!!

Should you keep Used sharps containers locked up?

2011-04-14T09:24:00.000-07:00

Should you keep Used sharps containers locked up?

This issue came up in a routine audit of a dental facility. The facilities compliance manager asked if the full sharps containers need to be locked up. Although regulated medical waste is not required to be locked up based on OSHA regulations, it is important to realize that state regulations may be in place and these would take precedence.

The best way to be secure is to go to the EPA website and look up Medical Waste Programs by State.

Go to http://www.epa.gov/wastes/wyl/stateprograms.htm

Johns Hopkins Hospital Study: LEGIONELLA BACTERIA MORE COMMON IN HANDS-FREE FAUCETS

2011-04-13T14:11:00.000-07:00

It seems that there are some major differences between manual faucets and hands-free faucets. The Johns Hopkins Hospital found that manual faucets work better for infection control practices. The hospital examined 20 hands-free faucets and 20 manual faucets in the same hospital care areas. The water samples from the hands-free faucets showed 50% of them growing the water-borne bacteria Legionella whereas only 15% of water samples from manual faucets showed Legionella.
Researchers weren't able to describe why there is an increased growth in bacteria in hands-free faucets, but suspected that the valves in the hands-free faucets have more surface area for bacteria to grow on.
The study was completed in 2009 and the 20 hands free faucets replaced. Any new construction will only utilize manual v alves at Johns Hopkins.

http://www.hopkinsmedicine.org/news/media/releases/latest_hands_free_electronic_water_faucets_found_to_be_hindrance_not_help_in_hospital_infection_control

Welcome To Dr. Don's Dental Blog

2011-04-13T12:29:00.000-07:00

I have created this blog to aid all dental offices and their teams in anything new and appropriate in dentistry today. After practicing for over 30 hyears and teaching for over 20 years, it became obvious to me that there is no single source for key issuses facing dentistry today: from infection control, to amalgam separation, to Bloodborne Pathogens, to new state and federal regulations. I'll cover them all.
I'll discuss regulatory, compliance, current issues and anything else appropriate to practicing dentistry.
Watch for our first post -- please comment!