Lesson learned: How the dental assistants at the heart of the Tulsa oral surgeon fiasco affect you and your career
Infection control in the dental office is everyone's responsibility
Unless you’ve been hiding under a rock the last few days, we’ve all heard about the Tulsa, Okla., dentist, Dr. Scott Harrington, who allowed his staff to perform illegal procedures, among numerous other violations.
The dental assistants at the forefront of this argument claim they were sent to seminars in Chicago to be trained on IV sedation, although it is not legal for dental assistants to perform IV sedation in Oklahoma. They claim they were doing what they were told to do by their employer … just doing their job. Have you ever questioned your employer about something you were told to do?
When the oral surgeon was questioned about his infection control procedures, he directed the questions to his team, saying, “They take care of that, I don’t.” It is the responsibility of the dentist to know what is going on in his or her practice. But isn’t it our responsibility, as well?
I worked for a dentist years ago, and on my first day I threw away the white plastic HVE tip. The lead assistant scolded me and told me that they cleaned them, placed them in a cold sterile solution, and kept them for reuse. I immediately went to the doctor and asked her why on earth something disposable would be kept. She had no idea they were being reused and was floored when I told her. She then went to the lead assistant and asked her about it in front of all of us. Her answer was, “That’s the way it was done when I got here four years ago, so I’ve done it that way ever since.” The doctor had no clue what was happening in her own office!
Throwing his assistants to the wolves isn’t going to help Dr. Harrington’s case, although his assistants can be held accountable and subjected to fines and imprisonment. Are you ready to go down with your boss if your actions are found to be illegal? Those who inspected the office claim instruments were found rusted, making them porous and unable to properly be sterilized. They said that needles were being reused, an autoclave hadn’t been tested in years, and that there were many more violations.
In light of the recent Tulsa oral surgeon fiasco, here are a few questions you need to ask yourself.
1. Are you educated about the laws in your state? A quick reference (and one I love to use) is www.danb.org, which has a “search by state” tab on the left hand side. You can look up what your state allows for dental assistants and expanded functions.
2. Do you use biologic monitors for your autoclave? Testing should be done weekly, and test strips submitted to a testing facility. Results are then emailed or mailed to your office quarterly. Keep those reports because patients may ask to see them, and if so you want them handy.
3. Do you have an OSHA appointed compliance officer in your office? Although it is everyone’s responsibility to see that universal precautions and OSHA and CDC guidelines are followed, this designated person is responsible for making sure everyone in your office has an annual update to changes for OSHA and new findings from the CDC, making sure all MSDS sheets are updated and maintained, gathering Hep B vaccination records, scheduling CPR recertification, and maintaining documents for an exposure control plan. If you don’t have a compliance officer yet, I suggest that one be appointed. And if you don’t know if you have the records I mentioned, get on it! They are mandatory and your doctor should be aware of the consequences of not having them. For a list of things you need, visit http://www.osha.gov/Publications/OSHA3187/osha3187.html.
4. Do you keep drugs in your office? If so, what is your procedure for maintaining records? All of the drugs dispensed on premises should be logged in and out. All of the patient records should show exactly what drugs were dispensed and in what quantity, no exceptions.
5. Are you reusing something that is disposable? There is no money to be saved on cleaning something meant for single use and reusing it. Disposable items are not made to be autoclaved or chemically disinfected. They are usually too porous to be properly cleaned, so that’s why they’re disposable. At what cost are you exposing your patients to risk?
6. Do you know of a teammate who is cutting corners on sterilization and disinfection? Nobody likes to be a tattletale, but the truth is, cutting corners hurts all of us. I sure don’t want the doctor working on me in a room that I don’t think is properly disinfected, with instruments that are not properly sterilized, such as in my case, where the doctor had no clue proper procedures weren’t being followed. If you have concerns, voice them.
7. Are you using broken or rusted instruments? Broken or rusted instruments cannot be properly sterilized or disinfected and should not be reused under any circumstances.
I am a huge advocate of education. This world of dentistry we live in is ever changing and growing. Continuing education is a must for everyone on the team, whether or not it is required. It is your responsibility to know the law. If you have a question about something, don’t be afraid to speak up. The best way to stop the spread of infectious diseases is to prevent them altogether. It is every teammate’s responsibility to ensure that proper guidelines are followed. Do your part to protect your patients and yourself.
Tija Hunter, CDA, EFDA, is a 1981 graduate of the Missouri College, and has more than 30 years of chairside experience. She is currently the office manager/chairside assistant to Dr. Eric Hurtte of O’Fallon Mo. She is a member of the ADAA, founder of the Dental Assistants Study Club of St. Louis, director of the Dental Careers Institute, and an independent consultant specializing in assistant training, team building, office organization, and CEREC assistant training. She can be reached at email@example.com, or find her on Facebook.