Falling Short is Risky Business

Prior to 1992, OSHA regulations specific to bloodborne pathogens didn’t exist, and employees in dental practices had little recourse if they felt they were at risk of occupational exposure. As a direct result of employees’ concern over a lack of protection provided by some employers, the OSHA Bloodborne Pathogens Rule emerged.

According to the Organization for Safety, Asepsis and Prevention (OSAP), during the mid-1990s, when the case of the Florida dentist who infected six patients with HIV became national news, there was public outcry (and subsequent legislation) to require certain precautions be taken to prevent disease transmission. Patient awareness and fear of infection, along with the late 1980’s uncertainty about the exact modes of HIV transmission, drove dental professionals to adopt universal precautions and begin considering all blood and certain body fluids as potentially harboring bloodborne viruses. Later, these expanded into standard precautions, which encompass all body fluids (with the exception of sweat) and all infectious diseases—not just bloodborne viruses.

“This changed the standard of care, and dental professionals who did not adopt these changes exposed themselves to potential liability if a patient or employee contracted or suspected they contracted an illness in the dental office,” explains the nonprofit association. “For the last five years, major infection prevention groups have refined their emphases, including a shift from the term ‘infection control’ to ‘infection prevention.’ Control indicates a reduction in numbers of cases, while prevention means elimination—‘zero tolerance.’”

The liabilities and risks that dentists face regarding infection control for both staff and patients extend beyond financial ramifications. For infection control lapses involving patients, there is the possible violation of state dental board regulations, which can result in fines and license suspensions for serious violations. For infection control lapses involving employees, there is the risk of OSHA violations, which also carry fines and penalties. In addition, civil liabilities can occur when an illness, or the serious risk of illness, to either patients or employees occurs. Lawsuits have resulted from issues involving needlesticks, dental unit waterlines, improper sterilization, etc.

“Ambulatory healthcare, including dentistry, is currently a center of attention for infection prevention in the United States. One article reported more than 30 major infection prevention breaches in ambulatory centers during the last 10 years,” OSAP says. “A few cases have been so significant in scale and egregious behavior that several states are considering making infection prevention malfeasants not just a tort issue, but also a criminal violation.”

To avoid infection control risks and liabilities, OSAP emphasizes that knowledge and communication are the best defenses. Dentists who ensure both they and their staff are aware of the Centers for Disease Control and Prevention guidelines, and state and federal regulations, are acting in a responsible manner. Regular training in infection control for all personnel, including the dentist, should be documented. Attendance as a team at such infection control CE courses as the OSAP Annual Infection Prevention Symposium should be followed by discussions in a staff meeting about what was learned in the course.

“All staff members must be aware of their facility’s infection prevention program. Progressive offices make it a point to actively involve office personnel (including input) in their facilities’ programs, often through regular office meetings,” OSAP emphasizes. “Patients must be aware of the activities performed by the office. Communication about infection prevention between office and patients, and among office personnel, is essential.”