In order to protect staff and preserve personal protective equipment and patient care supplies, as well as expand available hospital capacity during the COVID-19 pandemic, the Centers for Disease Control and Prevention (CDC) recommends that dental facilities postpone elective procedures, surgeries, and non-urgent dental visits, and prioritize urgent and emergency visits and proceduresnow and for the coming several weeks. This aligns with recommendations from the American Dental Associationexternal icon (ADA) and the American Dental Hygienists’ Associationexternal icon (ADHA) to postpone non-emergency and elective dental procedures, as well the Centers for Medicare and Medicaid Services (CMS)’s guidancepdf iconexternal icon that all non-essential dental exams and procedures be postponed until further notice.
Click here for the Interim Infection Prevention and Control Guidance for Dental Settings During the COVID-19 Response
Click here for general information for healthcare workers who are working with suspected/confirmed COVID-19 patients (from the CDC).
Click here for information about a risk guidance in your office (from the CDC).
Click here for information from the ADA for OSHA guidance for handling patients during the Coronavirus pandemic. We are generally classified as low or medium risk, because we do not work on known or suspected COVID-19 patients. If we performed aerosol producing procedures on known COVID-19 patients in a hospital setting, we would be considered high/extremely high risk. (This is very helpful information).
Postexposure Prophylaxis (PEP) Hot-line:
Trained medical professionals are on call 7 days a week to discuss procedures and the need for PEP after a needle stick: (888) 448-4911 or click here.
OSHA Compliance Checklists and Info:
For the latest and greatest information on infection control in dentistry, check out www.osap.org (Organization for Safety and Asepsis Procedures). They also have a fantastic OSHA checklist (click here) and are a great organization to join for the latest updates in infection control.
Here is a page the discusses what OSHA inspectors actually look for when inspecting an office as well as letters about specific situations: OSHA Enforcement Procedures
Stick Injuries and Sharps Info:
If someone in your office is stuck, DO NOT CALL ME!!! I often can’t be reached within 24 hours and you need to react quickly. If you have any questions about stick injuries, call the Postexposure Prophylaxis (PEP) Hot-line. (doctors on call 7 days a week to discuss the need for PEP after a needle stick): (888) 448-4911 or click here for web site.
Here’s an interesting article about stick injuries in hospital-based dentistry (where needlesticks may be more common than in regular dental practices because of the use of IV needles and different types of procedures); the article reiterates the importance of making all procedures as safe as possible. click here for article
Here is a great checklist from OSAP about what to do after a stick: click here
In the event of a stick injury , fill out this exposure report form and give it to the doctor when you and the source patient go for testing: click here
Here is a completed evaluation of a safety syringe that you can print out, go over with your office staff, and if you agree with the findings, place it in your OSHA notebook: (click here for evaluation)
Here is a sample OSHA needle safety plan to help you design a plan for your office, if you need one. It’s in a “Word” format so you can change it however you want: click here for OSHA needle safety plan
Not sure about your waterlines? Here are some test kits that are less than $5 /each and offer a simple test for bacterial growth (it is one of the tests that are mentioned in the ADA statement below): https://www.millipore.com/catalogue/item/mhpc10025 Order the Sampler kit, item number MHPC10025, and it’s $141 for 25 test kits.
Here are some great articles about cost effective and easy methods of treating your waterlines, (please note that Listerine has also been found effective when used in the same manner as the Scope and peroxide mixtures described in these articles), view or print articles using Adobe Reader.
The bib chain may be a source of cross contamination, so it’s important to disinfect or sterilize it. Here’s some information you might find helpful: OSHA Bib Chain Contamination
For information on how to test your ultrasonic cleaner to make sure it’s functioning properly, check out this article from Dental Economics: (click here)
MSDS forms: (We have to replace our existing MSDS forms with the newly formatted SDS forms. Many times, dental supply companies have SDS forms on their website that you can print out, as needed. If not, you can google the name of the chemical to find an SDS form.)
You are allowed to have an electronic SDS notebook. Just make sure you have a printed copy of your chemical inventory and a backup of your notebook. Also, make sure everyone in the office knows how to access the information, if necessary.
HIPAA Info, Forms and Checklists:
Go to the Handouts and Forms page for a complete list of available HIPAA forms.
HIPAA penalties can now run as high as $1.5 million per incident! Make sure you have a HIPAA manual that is completely filled out and current. Also, the program must be constantly maintained and updated, so have regular meetings and risk assessments to ensure that your program is current.
Here’s a form for an annual risk assessment that is actually a pretty good checklist for your HIPAA program (Laney’s HIPAA risk assessment). The HIPAA risk assessment will allow you to analyze your office for possible vulnerabilities and document the results, which should be done regularly to maintain your program. It should be used periodically, or whenever changes are made in your office, to evaluate your procedures related to patients’ private health information. This form is based upon HIPAA’s security risk assessment tool which can be accessed at the following page: Click here for the link.
Here’s a website that allows you sign up for a free newsletter about what’s going on in the world of HIPAA. It’s not just dental stuff, so don’t let it freak you out, but some of the information is very helpful: (Click here)
If a suspected breach occurs, this breach risk assessment can be used to help determine whether a reportable breach has occurred: HIPAA breach assessment
For specific questions and answers about HIPAA, go to the US Dept of Health & Human Services FAQ web link. This is an AWESOME resource! You can search for a term and they will show questions and answers related to that topic: (click here)
Here’s information about encryption and smart-phones and laptops: ( click here )
For new OSHA and HIPAA manuals, call the ADA catalog people at (800) 947-4746 (make sure you provide your ADA number; the prices listed are much higher for non-members.) For OSHA, you want the “Regulatory Compliance Manual”, which includes the update service and a CD ROM that allows you to customize forms (item #S696B, member price $275). The HIPAA compliance kit has the privacy and security information in one manual, plus a 3 year update service, and the customizable CD ROM,plus a basic HIPAA training DVD which can be used for new employees and for review purposes. The item # is J598 and the price for members is $300. They also have a package that includes the OSHA and HIPAA manuals and all the stuff listed above for $575 (Item # K017… and yes, there is apparently no discount for buying them together).
Click here for a new website designed to help offices with HIPAA compliance. It’s got some really great information and explanations, plus it’s adding state information, as well, so it should be a really great resource! http://www.healthinfolaw.org/home
Here’s free HIPAA Privacy training from the HIPAA folks at the Dept. of Health and Human Services: (click here)
Here’s information about how to perform and document a risk assessment in your office (they need to be done regularly to ensure compliance with the Security Rule): Risk Assessment Document – click here
Why encryption is necessary. One of the biggest problems we have is securing our computer’s information from a potential breach. Dealing with a breach has huge implications for a dental practice, so encryption is a great preventative measure. If someone steals your computers and more than 500 patients are involved, you have to notify the patients AND the local media! If the information is encrypted, the information is not considered usable and no breach has occurred. Here’s information from the HIPAA folks about what’s required to comply with encryption. This explains why encryption is the only security precaution that will stop a breach in the event that your computer, device, or a laptop or unencrypted phone (with access to your patients’ information) is lost or stolen. click here
Here is a short summary from HHS (the HIPAA folks): click here
Here is some other info for more specifics about what’s required (the actual encryption requirements can be obtained from this page so you can give it to your computer guy): click here
And here’s a general page about security from the HIPAA folks: click here
Here’s 5 great hints on keeping your computer system secure: click here
Security Breach: A new section of the HIPAA rules were put into effect as of September 2009. In the event of a security breach of your computer system, you are supposed to follow certain procedures to ensure that patients are notified that their information may have been compromised. For information on breaches according to the 2013 HIPAA Rules, check out this article: click here
In the event of a breach of unsecured personal health information, we are supposed to report it to the Department of Health and Human Services (HHS). If the breach involves more than 500 individuals in a single geographic area, we are supposed to notify our patients, the local media, and HHS as soon as possible (absolutely within 60 days of the breach); if it’s less than 500 individuals, we are to notify the patient(s) involved, then log it and notify HHS on an annual basis, (within 60 days of the end of the calendar year in which the breach occurred). Here is the site to fill out the HHS notification: http://www.hhs.gov/ocr/privacy/hipaa/administrative/breachnotificationrule/brinstruction.html
If there is a possible breach, it is assumed that a breach has occurred unless you analyze the situation and determine that the patients’ information was not compromised. If a reasonable person would determine that the information was compromised and a breach occurred, you have to follow the notification requirements; if there is no breach, file this completed form in your HIPAA notebook: (click here for “HIPAA breach assessment”).
Avoiding a breach: If your patients’ information is compromised (your computers are stolen, you lose a backup drive, someone hacks into your system) you have to report this breach unless your information is properly secured and encrypted. Click here for information about the importance of securing your information and the importance of encrypting your hard drive: (HIPPA Encryption Guidence)
Here’s a great resource for information about the laws regarding HIV testing in your state: click here
We are not included in the Red Flag Identity Theft Rules. No policies, no procedures, no fines, no worries! (The only exception may be if your office accesses credit bureaus before extending credit to a patient; if you do, these rules may apply to your office, so check with your attorney to make sure you’re in compliance.)
Dental X-rays and Radiation Safety
Here’s a great reference about radiation exposure levels. If your patients want to know how much radiation they receive from dental x-rays versus other sources of radiation, here’s something you can show them that’s very interesting (and reassuring!): (click here for dose chart)
X-Ray Badge Information: X-ray badges are only required for pregnant employees, as a general rule, but check with your local board to make sure it’s not required by your state. Click here for more informationThe Georgia Department of Community Health also recognizes that dental health care workers rarely receive enough radiation to require the use of dosimetry badges.
Here is an information sheet from the ADA about dental x-rays and safety. Please note they recommend the use of a lead apron with a thyroid collar when taking x-rays, so long as it does not interfere with the procedure. Here is an information sheet.
Disease, Health and Infection Control Info:
The diseases we worry about most in dentistry are HIV, Hepatitis B and Hepatitis C.
Here are some great links for information on these diseases.
The Human Papilloma Virus (HPV) is at epidemic proportions in North America, and it turns out that chronic HPV infection has huge implications for dentistry. Studies show that a significant amount of oropharyngeal cancer can be attributed to the human papilloma virus.
Check out these websites for more great information! http://oralcancerfoundation.org/(This is an incredibly helpful website on oral cancer; it has a specific dental section and a separate section on HPV-related cancers)
It’s important for health care workers to receive vaccinations for the flu and for any childhood diseases for which they don’t have immunity. Here’s the CDC’s vaccination schedule for health care workers: http://www.immunize.org/catg.d/p2017.pdf
Health Insurance Portability and Accountability Act (HIPAA): www.hhs.gov/ocr/hipaa/ (US Dept. of Health and Human Services)
For a great web site with information about the link between systemic disease and oral health, check out www.ZT4BG.com (which stands for zero tolerance for bleeding gums). There’s a section for the public and one for professionals, and it’s a great educational tool for patients who just don’t get the fact that oral health can determine the state of your entire health.
For information about latex allergies in dentistry,click here
Here you will find proven dental products and services that we have used and found to be reliable and reasonably priced.
Please note that I am not endorsing any listed companies, nor do I own them or get kickbacks, but they are good places to start if you’re comparing prices and trying to find specific information.
Postexposure Prophylaxis (PEP) Hotline (doctors on call days a week to discuss the need for PEP after a needle stick): (888) 448-4911 or click here for web site
For new OSHA and HIPAA manuals, call the ADA catalog people at (800) 947-4746 (make sure you provide your ADA number; the prices listed are much higher for non-members.) For OSHA, you want the “Regulatory Compliance Manual”, which includes the update service and a CD ROM that allows you to customize forms (item #S696B, member price $275). The HIPAA compliance kit has the privacy and security information in one manual, plus a 3 yr update service, and the customizable CD ROM,plus a basic HIPAA training DVD which can be used for new employees and for review purposes. The item # is J598 and the price for members is $300. They also have a package that includes the OSHA and HIPAA manuals and all the stuff listed above for $575 (Item # K017… and yes, there is apparently no discount for buying them together).
For a great lawyer in Georgia (and a nice guy) who deals with dentists and our issues, call Stuart Oberman: Oberman Law
For Biomedical Waste disposal, be VERY careful before signing up with Stericycle. Read any contracts and proposals very carefully; you don’t want to unintentionally get locked into a contract that will signficantly increase fees unexpectedly. Also, FYI, stericycle has changed THEIR policies about what items can go in sharps containers, NOT the federal regulations. There is NO new federal regulation at this time that states that empty carpules cannot go in sharps containers…that is all Stericycle. Please note that most states allow for empty anesthetic carpules to be disposed of in the regular trash. (Specifically, lidocaine with epi is exempted from P-list specific disposal requirements).
In Georgia, for sharps disposal, chemical and metal recycling, and just about anything else having to do with waste in Georgia, call MCF Environmental Services, Inc. Phone: 770-593-9434 They will give you a box for your sharps containers and will pick them upon demand, with no regularly scheduled pickup needed. Ask for Kevin at extension 5642, tell him Laney Kay sent you, and get $5 off the regular pickup fee.
For immediate relief from cold sores for you or your patients, check out Viroxyn: http://www.viroxyn.com/ (It’s amazing how this stuff works…my husband uses it.)
For a surface disinfectant that’s environmentally friendly AND is strong enough to kill TB in less than a minute, check out BioSurf! Either click hereor call for information: (877) 777-3303.
For products related to waterline testing and maintenance, take a look at this publication by the ADA: waterline ada statement The HPC Total Count Sampler in-office testing kits from Millipore run about $5.50 per test, so check it out!
To find a location for postexposure HIV/HBV/HCV testing, call 800-232-4636 or try this web site: www.hivtest.org. Many local health departments now offer rapid HIV testing, so consider them, as well.
For an air cleaning system that kills pathogens and removes harmful chemicals from the air we breathe, call KesAir Technologies and ask for information on the AiroCide. (800) 236-1846 or www.kesair.com . It also gets rid of our “dental office smell”…AMAZING!!!
(Tell them Laney sent you and you get a discount!)
Here are some fun, stylish, OSHA-compliant lab jackets that don’t make you look as big as a house! Check them out!” www.maano.net
MSDS/SDS forms: If you’re missing some forms, here’s a great place to find them and print them out: http://www.ehso.com/msds.php . You can also google the name of the chemical and the manufacturer and find it on the internet. Many of the dental supply companies have all of the available SDS forms for products they carry on their websites, so you can just print them out.
For a great selection of low-powder / low-protein and / or nitrile gloves to try, call The Glove Club (Colonial Glove Company) (800) 252-2425 and ask for a samples of whatever you want to check out. Another great place to check out gloves is Clinical Supply Co. (800)468-0188.
Autoclave Testing: For reasonably priced autoclave spore testing (weekly) check out North Bay Bioscience: click here
For amalgam recycling, check out the following list of amalgam recyclers and see which company works best for you.” click here
For a painless CPR training session in central Georgia, call Jill at Medical Training Specialists (478) 451-5091.
You never have to pay for posters in your office. Call the US Department of Labor (1-888-9SB-REFA) or go to the Department of Labor Poster Page and fill out the questionnaire to see which posters you need to print and post: http://www.dol.gov/elaws/posters.htm .
For state posters, call your state department of labor and worker’s compensation board and they’ll send them to you at no charge. Or, go to Google and type in “(your state name) required employee posters”. When the Google results come up, look for the state website, not a website that sells posters (it will generally have “.gov” or “.us” as part of the website address, such as “https://www.colorado.gov/pacific/cdle/posters“).