OnTarget Highlight: PPE Adherence in the Dental Practice

A recent global health pandemic has brought personal protective equipment (PPE) to the public’s attention, but dental professionals have long been familiar with the concept of PPE. As defined by the Occupational Safety and Health Administration (OSHA), PPE refers to “specialized clothing or equipment worn by an employee for protection against infectious materials.” For dental healthcare personnel (DHCP), sources of infection include blood, saliva, and other potentially infectious materials (OPIM) encountered in the workplace. Such materials can transmit an array of disease-causing pathogens, from the rhinovirus behind the common cold to the potentially life-threatening human immunodeficiency virus (HIV) and hepatitis B (HBV) and C viruses (HCV). PPE, as described by the Centers for Disease Control and Prevention (CDC), includes gloves, face masks or shields, protective eyewear, and protective clothing (e.g., reusable or disposable gowns, jackets, and laboratory coats). These items should be worn by DHCP whenever exposure to infectious materials can be reasonably anticipated.

To keep staff and patients safe, to avoid punitive measures from regulatory agencies, and to maintain the integrity of your dental practice, compliance with OSHA regulations is a necessity. The two primary standards applicable to dental offices are the 1991 Bloodborne Pathogens Standard and the Hazard Communication Standard, both of which call for the use of PPE. According to OSHA, PPE is “the last line of defense after engineering controls, work practices, and administrative controls.” Employers should prioritize creating safe work environments, providing employees with devices that maximize safety, and offering training that teaches workers the behaviors that will minimize exposure.

Once these measures are in place, PPE fills in the gaps, protecting DHCP when engineering, work practice, and administrative controls are not feasible or effective.

Despite the inherent risks of noncompliance, adherence to PPE protocols can be startlingly inconsistent, with research showing many healthcare workers either using equipment inappropriately, irregularly, or not at all. Several studies, including one published by the National Academies Press in 2008, document barriers to PPE compliance among healthcare personnel. The most commonly reported obstacles include a lack of time, the perception that PPE interferes with the ability to perform tasks, physical discomfort, difficulty communicating when wearing facial protection, and unavailability of equipment.

Overcoming these challenges and improving PPE compliance starts at the top. Both the legal responsibility of creating an effective PPE program and the greater task of cultivating a “culture of safety” – one that naturalizes the use of PPE – falls on management. The validity of a top-down approach has been proved, with data showing that workers who perceive an organization-wide commitment to safety are more than 2.5 times more likely to adhere to safety protocols than those who lack such perceptions. OSHA mandates that employers must not only select and provide proper PPE, but also train employees on how, when, and why to use it. Additionally, employers should continually monitor, evaluate, and adjust PPE products and protocols to ensure compliance. In the dental office, senior leadership can delegate at least some of these responsibilities to a permanent in-office infection control coordinator (ICC) and safety officer. These roles operate in tandem to develop, document, and preserve office safety and infection control protocols, including the use of PPE. Depending on staff needs, one team member can assume both ICC and safety officer roles, or the responsibilities can be divided among several members.

While establishing and monitoring PPE use is in the hands of the employer, upholding a culture of safety is a joint effort – employees must maintain personal accountability to ensure compliance. OSHA regulations are largely performance-based, delineating the indications for using PPE, but they do not explicitly state what kind of protection to use or how to use it. In addition to completing all employer- provided PPE training, employees can familiarize themselves with the types of PPE and procedures for donning and removing it available from the CDC and the Organization for Safety, Asepsis, and Prevention (OSAP). Essential references include the CDC’s Guidelines for Infection Control in Dental Health-Care Settings, 2003; 2016 Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care; and From Policy to Practice: OSAP’s Guide to the CDC Guidelines. Many charts, checklists, and infographics also are available on the CDC and OSAP websites, making it easier for staff to understand and adhere to PPE protocol.

PPE products

Many workers fail to adhere to PPE requirements because they find equipment cumbersome, uncomfortable, or disruptive to performing tasks and communicating with patients and personnel. To remove these barriers, leadership must supply PPE that maximizes ease of use, comfort, and performance. Patterson Dental offers a wide selection of PPE products so you can ensure that your practice is OSHA compliant, and your staff stays safe, healthy, and ready to deliver exceptional patient care.

Face masks

Gloves

Protective eyewear

Protective clothing

Selected references

Garland KV. Brush up on the basics of PPE. Dimensions of Dental Hygiene. October 12, 2017.

Govoni M. Creating a culture of safety in dental practice settings: Part one. Dental Economics. January 17, 2018.

Larsen EL, Liverman CT (Eds). Preventing Transmission of Pandemic Influenza and Other Viral Respiratory Diseases: Personal Protective Equipment for Healthcare Personnel: Update 2010. Washington, DC: National Academies Press: 2011.

Occupational Safety and Health Administration. OSHA FactSheet: Personal Protective Equipment. 2006.

Occupational Safety and Health Administration. OSHA FactSheet: Personal Protective Equipment (PPE) Reduces Exposure to Bloodborne Pathogens. 2011.

Pyrek KM. Addressing the challenges of PPE non-compliance. Infection Control Today. October 14, 2011.

RDH. Keeping yourself safe and healthy: Choose, then Use PPE. January 1, 2006.

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This blog post originally appeared in OnTarget. Read the full issue and see current highlighted promotions: pattersondental.com/dental/ontarget