As dental hygienists who also serve as consultants, we’ve heard these and similar concerns often since dental practices reopened. This question covers much of what we’ve heard. “My boss thinks COVID-19 is a joke. He wears the same mask for weeks, he has not washed his gown since we returned to the office in June, and he doesn't follow any Centers for Disease Control and Prevention (CDC) recommendations. The precautions I take are to protect myself, staff, and patients. How can I get him to see the light and realize how serious this is?”
Here's how we advise the people we talk with. When approaching this type of situation, it is essential to have an open mind and to understand why the person is not buying into the mandates and rules. Is this an emotional or financial response to COVID? Has this always been the culture in the practice, or is it new? Acknowledge the boss’s perspective and then discuss his obligations as a health-care provider who took an oath to do no harm. Although he believes COVID is not real, the dental practice has a legal obligation to the team and patients to adhere to Occupational Safety and Health Administration (OSHA) and CDC guidelines.
An important point here is not just the doctor’s safety, but patient safety. There is no way he can don and doff his personal protective equipment (PPE) that many times without cross-contamination. With each reuse, he is increasing his odds that a patient could be contaminated with a previous patient’s potentially infectious material. Though many people see infection control and PPE as a waste of money, giving a patient a health-care-associated infection will impact your wallet and your heart.
One of the first things to do is research whether your state is required to be CDC-compliant. This means that if your state’s dental board has written language in the State Dental Practice Act or any other written statute mandating that dentists and dental hygienists must adhere to the CDC recommendations, then those recommendations are required. If you live in a state like this, then the conversation might be a little easier and you can discuss how to support the dentist in adhering to the CDC recommendations. Be sure to mention that breaches can be reported by team members and patients, which could prompt an inspection.
If you practice in a state that does not follow CDC recommendations, then it’s a good idea to remind the dentist about the OSHA standards regarding PPE. These standards are federally mandated to be followed by every single dental practice in the United States. There are no exceptions. OSHA can inspect and close a dental practice if their standards are not being implemented.
Here are some more of our suggestions
- Have a one-on-one meeting with the dentist to discuss concerns about serious infection control breaches.
- Mention that he is breaking the law according to OSHA, which is federal and mandatory in every state regardless whether the state is CDC compliant.
- Review OSHA mandates and mention the dental practices that have been reported since the COVID-19 reopening phase. (Those offices can be found at osha.gov.)
- Mention that breaches can become a risk management issue. If a malpractice lawsuit occurs, infection control protocols are requested by opposing counsel to support the lawsuit.
- Finally, continue maintaining proper protocols regardless of whether the dentist is willing to adhere. There are other clinicians in the practice who can be sued. Adhering whether the dentist does or not will be critical for you.
India R. Chance, BSDH, RDH, is an independent compliance consultant who provides continuing education for dental professionals to improve their knowledge of infection prevention and safety in their workplace environment. Nationally, she has trained dental practice teams to implement and strengthen their dental safety programs as well as provide one-on-one coaching to many dental practice owners. She is the leading dental compliance speaker for the Washington, DC, metropolitan area.
Michelle Strange, MSDH, RDH, has been a dental clinician since 2000 and is currently a practicing hygienist, speaker, writer, content developer, consultant, and podcast cohost for A Tale of Two Hygienists. With a belief in lifelong learning, she hopes to continue to grow within the dental profession and one day see the gap bridged between medicine and dentistry.
