Safety is No Accident
October 1, 2020
By Lisa Germain, DDS, MScD
One of the greatest joys of serving as clinical director for DC Dental is the opportunity I have to interact with clinicians who have new ideas, unique skill sets, and expertise in areas that I am…“unaccomplished”. Time and again I am reminded that I don’t know what I don’t know. This has never been truer than during the SARS COV-2 pandemic where everything has been laced with a modicum of uncertainty. One thing that I knew for certain was that I needed to up my game in the field of infection control and OSHA compliance. I just really did not know where to start.
Call it serendipity, or just plain luck when I scheduled India Chance RDH, Founder of “Learn2Prevent” in the beginning of 2020, before the pandemic started, to give webinars on both OSHA compliance and infection control during the second and third quarter of the year. Little did I know that she would become a guiding light for me and my team throughout this challenging time. In addition to giving me peace of mind, she gave me the tools I needed to create a safe environment for my team, my patients, as well as me personally. All the while I was amazed at her fresh perspective, frequent updates, attention to detail and new creative resources for compliance and protection. On top of that, I just “binge listened” to her podcast which is chuck full of pearls and food for thought.
I am sure you can see why I was thrilled once again when she agreed to let me interview her for my quarterly article.
Me: India, it has been quite a year. Thank you for taking the time to let me interview you!
India: Hi! Thanks so much for having me, it’s a pleasure to chat with you.
Me: The first thing I want to ask you is this: While as dental healthcare workers we have always taken universal precautions, how has the pandemic changed our approach to infection control?
India: I think the pandemic has made many practices re-evaluate their pre-COVID protocols & remind them that it is essential to maintain a strong Infection Control program. It’s highlighted some of our weaknesses as well as educate many of us on how Standard Precautions should be implemented moving forward. For an infection control nerd like me, it’s been great to see dentistry rise to the challenge to make sure we are delivering dental care in a manner that protects our teams & our patients.
Me: Are there any special or new OSHA regulations that need to be addressed during this time?
India: OSHA did release interim COVID19 guidance regarding protocols that ensure workplace safety & created an awesome page on their website entitled “Dentistry Workers & Employers”. It reviews employee exposure risk levels, admin controls, engineering controls, PPE, & safe work practices specific to dentistry. It’s a great read & offers a plethora of information that pertains to the current climate that dental practices are experiencing.
Me: One thing that I know people find very confusing is the issue of which mask is appropriate for which worker or for which procedures. Can you explain the difference in the mask levels and discuss the mask fit test?
India: Ahhh yes, this is such a popular topic & gets so much engagement on social media. It really boils down to which procedure you are performing. For instance, if you are performing a non-aerosol generating procedure like taking impressions or radiographs, then the level of mask is different than if you are performing a crown prep or Cavitron assisted prophylaxis. Since COVID19, the rules have changed & the CDC has recommended a respirator mask be worn any time you are delivering any procedure so adhering to that is top priority. In normal circumstances, there are 3 levels of surgical masks – a Level 1 surgical mask is ideal for a low spray & splatter procedure like an exam or when taking impressions, a Level 2 mask is ideal for a moderate spray & splatter procedure like prophylaxis using handscaling only, & a Level 3 mask is ideal for a heavy spray & splatter procedure like a crown prep, restoration, surgery, or Cavitron assisted prophylaxis.
As far as the fit test, that only applies to respirator masks & it’s required by OSHA annually for any person that will don this type of mask while delivering dental treatment. Initially it is to be accompanied by a medical evaluation to determine if the user is medically fit to wear a respirator mask because this type of mask can cause your lungs to work twice as hard to breathe. If the user has a history of respiratory issues, it’s not recommended. In addition, to make it even more complicated, OSHA states that a fit test must be performed on each brand of respirator mask which has proven to be quite the challenge for our industry. Not sure how sustainable that will be moving forward.
Me: Tell me more about your concept of having a designated person in every office that is an Infection Control Coordinator as well as the resources that you provide to train that person.
India: Well it’s not really my concept nor is it new, the CDC has recommended dental practices designate someone for this role since 2003. Isn’t that crazy… this has been on the books for 17 years!! There have even been a few published articles addressing the fact that only 45% of the dental practices in the US have an Infection Control Coordinator or an ICC. That’s mind blowing to me but with the onset of COVID, a light has really been shined on the importance of having someone designated in your practice to fill this role. The ICC’s main task is to execute the infection control program & ensure that compliance is being maintained on a daily basis. Because many practices had never even heard of the ICC role, I decided to partner with a colleague, Michelle Strange, RDH to create an on-demand training program dedicated to this role called Level Up Infection Prevention. We realized dental practice owners needed help to equip that one team member to competently fill this role so that the practice could deliver the safest dental visit possible. It’s gotten a great response & we are excited to spread this message.
Me: On your podcast you talked about legacy errors and I have to admit, it really hit home for me. I had to wonder just how complacent I had become. Can you tell our readers more about what happens if you don’t re-evaluate infection control procedures on a regular basis?
India: It’s funny you say that Lisa because I think we have all been guilty of being complacent at one time or another. I mentioned legacy errors because when I visit offices to conduct mock dental board inspections, I come across infection control breaches all the time. I never jump to conclusions or make accusations because sometimes these breaches occur due to an employee performing a task a certain way & they have handed it down to the new hire – that’s a legacy error. I mean you have to train new hires right?…but the issue arises when new hires are trained to perform tasks that are not in compliance with OSHA or the CDC. That can become a huge risk management issue for practice owners & definitely result in violations should a dental board or OSHA inspection occur. Re-evaluating your infection control procedures provides you the opportunity to discover breaches & strengthen areas where complacency exists so that you can avoid legal drama.
Me: India, can you list the various resources that you provide and let our readers know how to find out more about them and you as well?
India: Sure! My company, Learn2Prevent, provides Infection Control & OSHA team training, mock inspections, & coaching to dental practices across the country. We help practice owners get safely back to business so they can focus on dentistry. Visit www.learn2prevent.com to learn more.
You can also check out the podcast I co-host with Michelle Strange called Level Up Infection Prevention where we deliver Infection Control nuggets for practice owners to save time & money! Listen on any podcast app or visit www.levelupip.com
Me: India, I again can’t thank you enough for spending the time with me today. Your devotion to teaching is exceptional and I really look forward to having you back as a speaker on the webinar series again very soon!
Thanks again Lisa – this has been a blast! Stay safe & remember, Safety is no Accident!