Thursday Troubleshooter: RDH refuses to wear gloves while carrying dirty cassettes or dentures

This dental professional is concerned about infection control in her practice. An RDH refuses to wear gloves sometimes, and the dentist will not confront her with the problem. What can be done?

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Nearly everyone has problems and concerns on the job, and sometimes you're just too close to a situation to solve something yourself. Share your concerns with Team Troubleshooter, and the experts will examine the issues and provide guidance. Send questions to megk@pennwell.com.

QUESTION: I work in a busy general practice with two doctors, four hygienists, and three assistants. One of the hygienists is continuously coming into the lab with bare hands carrying dirty cassettes or dentures and partials to be cleaned in the ultrasonic. Both doctors are aware of this problem and will not confront her about it. Rather, they address issues to the staff as a whole instead of confronting the guilty employee. This employee chooses to ignore what they discuss. Many of us are fed up with her behavior and wonder why an employee is allowed to repeatedly break the chain of infection control and put not only patients, but the entire staff at risk. Any suggestions or advice is appreciated.

Hand Germs

ANSWER FROM KAREN DAW, MBA, authorized OSHA trainer, consultant on safety, and owner of Karen Daw Consulting:
It sounds like there are two concerns. The first is the employee who is either unaware or unconcerned about the risk of transmitting infectious diseases. The second is whether the employer is effectively communicating and enforcing safety expectations.

When I moved, I immediately began searching for a new dental office. At my first prophy the hygienist explained that the office was extremely busy and she didn’t have time for lunch. She then asked if I would mind if she had a quick snack. I felt so bad for her that I agreed. She thanked me, reached into her purse, set an individual serving of cookies on the bracket table, and proceeded to nibble on them, all with her gloves still on! Needless to say, I now go to a new practice.

Your coworker and this hygienist should have been educated on proper infection control practices. This includes providing care that is safe for both patients and employees. Is your office participating in bloodborne pathogens training upon hire and at least annually as required by the Occupational Safety and Health Administration? How about annual infection control training that includes the Centers for Disease Control and Prevention guidelines? Both types of training cover hazard assessment, preventing exposures, and the use of personal protective equipment such as masks, gloves, gowns, and eyewear.

After training, the office should discuss how the requirements and guidelines under these agencies apply in the practice. For example, the need for utility gloves and proper transport containers when moving dirty cassettes from the operatory to central sterilization could be covered. What could also be included is how to prevent the transmission of bloodborne pathogens like HIV and Hepatitis B and C. This may persuade the hygienist to don exam gloves when handling dentures and partials.

Whether the hygienist is unaware or chooses to ignore the requirements, the employer is ultimately responsible for providing a safe work environment under OSHA. The doctor could use the infection control breaches as a teaching moment by addressing the entire office; however, it is clearly not having the intended effect. The doctor should be warned that serious and willful fines under OSHA can be over six figures. One dental office I know of was cited $76,500 after one exposure incident.

Share with the doctor your commitment to the success of the practice. Then explain what you observed and the impact it has on patient perception, and that there may be dental board and OSHA violations. Provide the doctor with specific examples of your observed breaches with dates, and how it is affecting employee morale. OSHA and the CDC state that every office should appoint someone to oversee a safety program. Enlist this person’s assistance when it’s time to meet and discuss solutions.

Expressing your concern, why all of this matters, and offering a possible resolution should help move the process forward. It’s all about doing right by your patients and the employees. The office is lucky to have you. Good luck!

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