About the AuthorSheila Dunn, DA, MT (ASCP), holds a doctoral degree in clinical laboratory science from the Catholic

University of America in Washington, DC. She has helped thousands of outpatient medical facilities comply

with federal regulations such as CLIA and OSHA through her presentations at a nationwide seminar series.

She has written more than 150 articles about regulatory issues and healthcare delivery systems and serves

as an advisor to numerous companies.

12E

©2005–2012. HCPro, Inc. All rights reserved, including right of reproduction. The author(s) and their agent(s) have made every reasonable effort in the preparation of this publication to ensure the accuracy of the information. However, the information in this book is sold without warranty, either expressed or implied. The authors, the editors, their agents, and the publishers will not be liable for any damages caused or alleged to be caused directly, indirectly, incidentally, or consequentially by the information in this publication. This publication cannot and does not provide specific information for a user’s exact situation. Users of this publication should exercise their own judgment and, where appropriate, seek the assistance of legal counsel regarding their particular situation.

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OSHAPROGRAMMANUALfor Dental Facilities

OSHA Program Manual for Dental Facilities is published by HCPro, Inc.

Copyright © 2012 HCPro, Inc.

All rights reserved. Printed in the United States of America. 5 4 3 2 1

ISBN: 978-1-60146-744-7

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HCPro, Inc., is not affiliated in any way with The Joint Commission, which owns the JCAHO and Joint Commission trademarks.

Sheila Dunn, DA, MT (ASCP), AuthorDavid A. LaHoda, Managing EditorElizabeth Petersen, Special Projects EditorLauren McLeod, Editorial DirectorMike Mirabello, Senior Graphic ArtistMatt Sharpe, Production SupervisorJean St. Pierre, Senior Director of Operations

Advice given is general. Readers should consult professional counsel for specific legal, ethical, or clinical questions.

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05/201221967

TAB 3: GENERAL FACILITY SAFETY

Contents

Keeping Employees Safe ................................................................................. 3-1Important Phone Numbers & Contacts ...................................................................................3-1Emergency Phone List ............................................................................................................3-2

Fire Safety ......................................................................................................... 3-3Automatic Sprinkler Systems ..................................................................................................3-3Fire Alarms ..............................................................................................................................3-3Fire Procedures: Immediate Actions .......................................................................................3-3Building Evacuation ................................................................................................................3-4Fire Extinguishers ...................................................................................................................3-4

Purchase the Right Extinguisher .....................................................................................3-5How Many Fire Extinguishers to Have & Where to Put Them ........................................3-6How to Use a Fire Extinguisher: The “PASS” Technique ................................................3-6When to Extinguish Fires with a Portable Fire Extinguisher ...........................................3-6

Fire extinguisher supplement ......................................................................... Supplement

When NOT to Extinguish Fires and to Evacuate ............................................................3-7Fire Extinguisher Inspections ..........................................................................................3-7Fire Extinguisher Maintenance .......................................................................................3-7

Fire Drills .................................................................................................................................3-7

Electrical Safety ................................................................................................ 3-8Physical Characteristics of a Safe Dental Facility ........................................ 3-8

Air Quality ...............................................................................................................................3-8Mold ................................................................................................................................3-9

Mold Remediation ...................................................................................................3-10Aisles ......................................................................................................................................3-11Emergency Lighting ................................................................................................................3-11Employee Dress Code ............................................................................................................3-11Exits, Means of Egress ...........................................................................................................3-11Exit Doors ...............................................................................................................................3-12Exit Signs ................................................................................................................................3-12Floors ......................................................................................................................................3-13Lighting ...................................................................................................................................3-13Noise .......................................................................................................................................3-13Portable Space Heaters ..........................................................................................................3-14Restricted Access Areas .........................................................................................................3-14Sinks .......................................................................................................................................3-14Storage ...................................................................................................................................3-14Dental Lab Equipment ............................................................................................................3-14Air Compressors .....................................................................................................................3-14

Page

Systems Failure ................................................................................................ 3-15Evacuation Plan ................................................................................................ 3-15

Evacuation Procedures ...........................................................................................................3-16Evacuation Route ...................................................................................................................3-17Example Evacuation Floor Plan ..............................................................................................3-18

Emergency Preparedness Supplies ............................................................... 3-19Emergency Action Procedures ....................................................................... 3-19

Bioterrorism: Suspicious Letters or Packages ........................................................................3-19What is a “Suspicious Package ......................................................................................3-19

Bomb Threat ...........................................................................................................................3-20If You Discover a Bomb or a Suspicious Item .................................................................3-20Explosion ........................................................................................................................3-20

Civil Disturbance .....................................................................................................................3-21Earthquake .............................................................................................................................3-21

If a Tremor Occurs when You Are Inside .........................................................................3-21After the Tremor Is Over .................................................................................................3-21

Severe Weather ......................................................................................................................3-22Flood ...............................................................................................................................3-22Hurricane ........................................................................................................................3-22Severe Thunderstorm or Tornado Warning .....................................................................3-22Tornado Safety Tips ........................................................................................................3-23Severe Thunderstorm or Tornado Watch ........................................................................3-23Toxic External Atmosphere .............................................................................................3-23

Violence ..................................................................................................................................3-23OSHA’s Jurisdiction Over Workplace Violence................................................................3-23Violence Prevention Plan Introduction ............................................................................3-24Overview of Violence Prevention Plan Components ......................................................3-24

Part 1 .......................................................................................................................3-24Part 2 .......................................................................................................................3-30

More Sources for Prevention of Workplace Violence .....................................................3-31

First Aid ............................................................................................................. 3-31First Aid Kit ..............................................................................................................................3-31Basic First Aid for Common Emergencies ..............................................................................3-32

Crash Kit/Cart Components ............................................................................ 3-34Drug-Free Workplace Program ....................................................................... 3-36Service Animals ................................................................................................ 3-41Holiday Decorations ......................................................................................... 3-43

Sample Checklist: Spot Check Your Facility’s Holiday Decorations .......................................3-43

Safe Decorations and Displays Policy ........................................................... 3-45Slip, Trip, and Fall Prevention ......................................................................... 3-47Healthcare Facility Slip, Trip, and Fall Hazard Checklist .............................. 3-50

Contents

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OSHA Program Manual for Dental Facilities

Look for these hazards in medical records; pharmacy; areas with elevated storage; kitchens, break rooms and pantries; outdoor work situations.

Be sure to instruct employees about maintaining three points of contact with the ladder and stepstools at all time while ascending and descending (two hands and one foot or one hand and two feet).

Tripping Hazards: Clutter, Including Loose Cords, Hoses, Wires, Medical TubingStorage areas, work areas, hallways, and walkways can accumulate clutter leading to potential STF incidents such as exposed cords on the floor that can catch an employee’s foot and lead to a trip.

Look for these hazards at nurses’ stations; operating rooms; exam and patient rooms; computer workstations; storage areas; hallways and walkways.

Improper Use of Floor Mats and RunnersMats can be useful to prevent STFs by providing slip-resistant walking surfaces and absorbing liquid, but improperly placed and maintained, mats can contribute to STFs.

Look for these hazards at facility entrances; laboratories, under sinks; water fountains; food preparation and serving areas.

Good prevention strategies include choosing sufficiently large mats at entrances; using non-slip mats where employees may routinely encounter wet flooring; selecting beveled-edge, flat, and continuous or interlocking mats.

ReferencesSlip, Trip, and Fall Prevention for Healthcare Workers, NIOSH, December 2010, www.cdc.gov/niosh/docs/2011-123/

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OSHA Program Manual for Dental Facilities

HeaLTHCaRe FaCILITy SLIp, TRIp, and FaLL HazaRd CHeCkLIST

Read each statement and place a check mark in the box indicating either Yes or No. If a check mark falls in a shaded box, that indicates a hazardous condition may be present and needs further attention. This is a comprehensive check created by NIOSH from Slip, Trip, and Fall Prevention for Healthcare Workers. Some hazards or areas of concern may not apply to your specific healthcare facility.

yes no LocationContamination and Irregularities (Indoor Walking and Working Surfaces)Do tiles, linoleum, or other flooring have holes, cracks, or bumps?Is carpeting buckled, loose, or frayed? Are carpet edges curled up?Does floor feel greasy or slippery?Are liquid contaminants present (water, grease, oil, cleaning solutions, coffee, body fluids)?Are dry contaminants present (powder, sawdust, dirt, flour, food, wax chips)?Are there sudden changes in indoor floor elevation > 1/4”?Are there metal grates or mesh flooring in the walkway?Are water absorbent walk-off mats used in entrances?Are slip-resistant mats used in wet areas?Are there gaps, cracks, or holes in the outdoor walkway > 1/2”? Are there metal grates or mesh flooring in the walkway? Is the walkway uneven, with abrupt changes in level > 1/2”? Is there debris (pebbles, rocks, leaves, grass clippings) on the walkway? Are there any slippery conditions present (water, grease, ice, snow)? Are concrete wheel stops in the parking areas highlighted with paint? drainage: pipes and drainsAre drains clogged or filled with debris?Are pipes splashing water onto a walking surface?Are outside drain pipes or down spouts spilling water on walkways?Are pipes properly aligned with drains inside and outside of the facility?

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OSHA Program Manual for Dental Facilities

yes no LocationWeather Conditions (Ice and Snow)Are bins containing ice melting chemicals and scoops provided at areas of heavy pedestrian traffic?Are ice-melting chemicals swept up once walkways are dry?Is winter weather communications distribution system in place?Is snow removal appropriately scheduled?Stairs and HandrailsAre all handrails 34–38” from the floor?Are handrails provided on slopes, ramps, stairs?Do handrails extend at least as far as the last step?Are handrails provided at steps (employee shuttle bus stop, entrances, conference and training rooms)?Are the edges /noses of each step painted or marked?Are stairway risers and steps all of uniform size?Tripping Hazards (Clutter, Loose Cords, Hoses, Wires, and Medical Tubing)Are cords bundled using a cord organizer?Are cords on the floor covered with a beveled protective cover or tape?Are cords mounted under the desk or on equipment?Are hallways, stairs, and walkways clear of clutter (boxes, cords, equipment)?Is there appropriate storage (closet, shelves, hooks, lockers)?Are stepstools available for use in areas with overhead storage?Do rolling office chairs have a sturdy base (no less than 5 legs)?Lighting (Check both inside and outside the healthcare facility.)Are light bulbs burned out?Are any areas dim, poorly lit, or shadowy? Are lighting levels compliant with local codes, ANSI, and/or Illuminating Engineering Society (IESNA) recommendations?MatsDo mats have abrupt squared-off edges, lacking a bevel?Are mat edges curled up or flipped over?Do mats slide around on the floor?

(Healthcare Facility Slip, Trip, and Fall Hazard Checklist, page 2 of 3)

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OSHA Program Manual for Dental Facilities

yes no LocationSlip-Resistant ShoesAre employees wearing slip-resistant shoes (safety shoe marketed as slip-resistant)?Do shoe soles have worn-down tread?Is the shoe sole tread clogged with dirt, food, debris, or snow? Are employees that must work outside wearing slip-resistant footwear?Visual CuesAre changes in walkway elevation highlighted?Are curbs highlighted?Are highly visible wet floor signs available and used correctly?Are barriers available and used to prevent access into wet or dangerous areas?Are wet floor signs removed promptly once floor is dry/ clean? Safety productsAre the following products available and conveniently located throughout the facility?

–– Wall-mounted spill absorbent pads or paper towels?–– Cups near water fountains?–– Trash cans?–– Pop-up tent floor signs?–– Umbrella bags?–– Barrier and access restriction devices?

employee Communication (Training and employee Involvement)Do all employees know the contact number for the housekeeping department?Are winter weather warnings distributed to staff through email?Are all employees aware of the housekeeping procedures?Do employees know where safety products are stored?Are cleaning methods for all floors and paths recorded and displayed?Are employees that use ladders trained in safe ladder use and maintenance?

(Healthcare Facility Slip, Trip, and Fall Hazard Checklist, page 3 of 3)

TAB 8: MASTER RECORD FORMS

Contents

General Equipment and Facility RecordsForm 1 Safety Report…………………..…................ Use to document employee complaints; staff

meeting minutes.Form 2 Autoclave Log…………………..………........ Use weekly or as indicated to record performance of

biological indicator tests.Form 2-A Eyewash Station Weekly Check Log........... Use weekly to record performance of emergency

eyewash station.Form 3 Annual OSHA Safety Program Review….... Use annually to document that this manual was

reviewed and updated.Form 4-A Weekly Facility Review Checklist................ Use weekly (optional form).

Form 4-B Monthly Facility Review Checklist................Use monthly (optional form).

Form 5 Annual Facility Review Checklist…….......... Use annually.

Form 5-A Fire Drill Evaluation Form.............................Use at least once per year

Form 5-B Employee Fire Drill Participation Sign-up Sheet...............................................

Use at least once per year

Form 6 Housekeeping Schedule………..…….......... Use initially.

Form 6-A Healthcare Facility Slip, Trip, and Fall Hazard Checklist....................................

Use as needed.

Bloodborne Pathogens RecordsForm 7 Bloodborne Pathogens Exposure

Determination List #1………………….........Use initially and whenever new clinical staff is added.

Form 8 Bloodborne Pathogens Exposure Determination List #2………………..….......

Use initially and whenever new clinical staff is added.

Form 8-A Bloodborne Pathogens PPE Compliance Checklist…………..…...….......

Use periodically to monitor compliance with the PPE sections of the bloodborne pathogens standard.

Form 8-A1 Failure to Use PPE..................................... Use to investigate incident.Form 9 Safety Needle/Syringe Evaluation Form…. Use initially and whenever new safety devices are

under consideration.Form 9-A Sharps Disposal Container Locations......... Use periodically to monitor compliance for sharps

disposal container locations.Form 9-B Bloodborne Pathogens Compliance

Checklist: ECP, Training, and Records........Use periodically to monitor compliance for sharps disposal container locations.

Form 10 Sharps Evaluation Results Form…….......... Use initially and whenever new safety devices are under consideration.

Form 10-A Exposure Prevention Checklist.................... Use periodically to monitor compliance for sharps disposal container locations.

Contents

Bloodborne Pathogens Employee Medical RecordsForm 11 Accident Report/Sharps Injury Log.............. Use when an employee injury occurs, including sharps

injuries and other bloodborne pathogens exposures. Form 11-A Sharps Injury Log.........................................Use to compile sharps injury device data for

sharps evaluation.Form 12 HBV Vaccination Declination Form……....... Use when an employee is given the hepatitis B vaccine

or declines this vaccine.

Form 13 HBV Employee Vaccination Form…….........Use when an employee is given the hepatitis B vaccine or declines this vaccine.

Form 14 Post-exposure Checklist…………….…........Use to document that all required actions were taken after a sharps injury or employee exposure to bloodborne pathogens.

Form 15 Post-exposure Medical Evaluation Declination Form………………….................

Use to document a particular employee refusing post- exposure testing and treatment.

Form 16 Source Patient Testing Consent Form…………………..…..…..........

Use to obtain consent from a source patient after an exposure incident such as a needlestick.

Hazard Communication Records Form 17 Hazardous Substances List…….……......... Use initially to list all hazardous chemicals in

your facility and when a new hazardous chemical is introduced.

Form 18 MSDS Request Letter…………..…….......... Use when a new hazardous chemical is intro duced to document attempts to procure a MSDS.

Training RecordsForm 19 New Employee OSHA

Orientation Checklist……………………......Use to document initial OSHA training when new staff members are added.

Form 20 Annual Employee Training Record….......... Use annually.

Form 20-A Respiratory Protection Training Record……Use annually.

Form 20-B Qualitative Respirator Fit Test Report……... Use annually when requiring a respirator or when changing respirator selection.

TB / Infection Control Records Form 21 TB Risk Assessment Results Form…......... Use annually.

Form 22 TST Record……………..………………....... Use as indicated, based on your facility’s risk assessment.

Form 23 TB Skin Test Declination Form………......... Use when an employee declines receiving a TB skin test.

Form 24 TB Exposure Log……………….…...…........ Use as indicated when employees are exposed to a known TB patient.

Form 25 Influenza Vaccine Log………....………........ Use annually to vaccinate all employees.

Form 25-A Influenza Vaccine Declination Form….......... Use when an employee declines this vaccine.

Form 25-B Checklist for Infection Prevention for Outpatient Settings.........................................

Use initially and at least annually thereafter.

Form 25-C List of Infection Prevention Contact Persons and Roles/Responsibilities..............................

Use initially and whenever infection prevention roles and responsibilities change.

OSHA Program Manual for Dental Facilities

Form 20-B

QUALITATIVE RESPIRATOR FIT TEST REPORT

It is the responsibility of the employer to follow and comply with requirements for the written program, medical clearances, fit testing and training following 29CFR1910.134 (including Appendix A and B1). It also is the responsibility of the employer to follow the recommendations of the manufacture of the respirator and fit testing kits.

Employer: __________________________________________________________________________________

Subject’s Name: __________________________________ DOB: __________________________________

Medical evaluation current: _________________________________________________________________

Respirator make: _________________________________ Model: __________________________________ Mask Size: q S q M q L Cartridge type: _______________________________________

Test Agent: q Irritant smoke q Banana oil q Saccharin q Bitrex Sensitivity check: q Irritant smoke q Banana oil q Bitrex squeezes __________ q Saccharin squeezes __________ (Bitrex/Saccharin …no eating/smoking/drink 15 min prior to test)

Fitting: q Positive pressure seal check q Negative pressure seal check

Appropriate PPE worn during the fit test procedure: _________________________________________The mask will be worn for 5 min. prior to the test: ___________________________________________Facial hair cannot cross the seal of the facepiece: ___________________________________________

Exercises: All exercises are 1 minute eachq Normal breathing q Deep breathing q Turning head side to side q Moving head up and down q Talking/counting reciting q Bending over or joggingq Normal breathing

q Pass q Fail

Subject’s signature: ___________________________________ Date: _______________________________

Tester’s signature: ____________________________________ Date: _______________________________

Source: Printed with permission from Maine Department of Labor Workplace Safety & Health