From the Winter 2020 Journal of the Colorado Dental Association
It’s hard to find many members of the dental community who don’t know the name Kim Laudenslager, R.D.H. She’s a local household (practice-hold) name in dental offices and a true ambassador of Occupational Safety and Health Administration (OSHA) education. Each year, she teaches courses in Colorado and nationwide to be sure dental providers are trained to keep themselves and their patients safe in a healthcare environment. She is a true expert on infection control in the dental office and 2020 marks her 30th year presenting annual OSHA/Infection Control Seminars. Have you ever been curious about the questions an OSHA expert receives every day? What about the most misunderstood parts of infection control? The following highlights the answers to those questions and how infection control has changed in 30 years.
When did you start teaching OSHA? What made you leave a hygiene practice to teach OSHA full-time?
Ha! Full-time? That’s funny. My OSHA seminar business has always been something I do part-time and I think the fact I continue to work clinically has greatly contributed to my passion and love of teaching. I started presenting seminars in 1990 and continued to teach at the University of Colorado School of Dental Medicine and practice hygiene part-time until just a few years ago. I have served as the director of hygiene examinations for the Central Regional Dental Testing Service (CRDTS) since 2006 and this means I visit numerous dental and dental hygiene schools across the country every year. In addition, I’m lucky to have lots of dental practices invite me to their offices to conduct training. Visiting and working in all these different dental settings helps me appreciate and stay up to date with current practices.
What was the “hot” topic when you started training offices?
Hands down, no pun intended, the transition from wet-finger dentistry to gloved dentistry was the “hottest” topic in the mid-80s and early 90s. Of course, the driving force behind all of this was HIV.
As a refresher and history lesson, the AIDS epidemic was first recognized in the U.S. in 1981. HIV, the virus that causes AIDS (thankfully, a word we hardly ever use today), was not isolated until 1983. From 1981 to 1987, the average life expectancy for people diagnosed with AIDS was 18 months. Between 1985 and 1990, we had 51 healthcare workers contract (and die) from HIV that they had contracted from their patients. Although none of the 51 were dental professionals, it was a time of extreme uncertainly for everyone in healthcare.
In August 1987, the Centers for Disease Control and Prevention (CDC) published guidelines designed to minimize healthcare worker exposure to bloodborne pathogens and then OSHA came on the scene in 1991 when they released their original Bloodborne Pathogens Standard. Finally, we had some official guidance when that was published, but for most us, we still needed a whole lot of clarification. That’s where I came in and that’s where I still am today. Even though the CDC and OSHA continue to issue guidance, many dental offices need help understanding and implementing the guidelines.
What OSHA topic or issue continues to cause calls and questions?
The most frequently asked question I get is, “Is that a requirement or a recommendation?” In other words, “do I have to do this or is it optional?” My answer, thanks to the Colorado Dental Board Rule XVI, is that all guidelines listed in the applicable CDC and OSHA documents are enforced (mandated) by law. Nothing is optional. Everything listed in the CDC and OSHA guidelines is mandatory, required and enforced.
What OSHA topic is most misunderstood or violated?
The top OSHA and CDC violations I see on a regular basis are about OSHA/CDC compliance officers, annual training, record keeping, weekly spore testing and lab coats. Here is some additional detail on each of those topics, which seem to be most misunderstood.
- Office OSHA/CDC Compliance Person
a. It is required that ALL offices assign ONE person (not two, not three—just ONE person) to be their OSHA/CDC officer.
b. Many offices “assign” someone but they do not allow them time to do the job! It’s not a full-time job and it’s not even a semi-part-time job, but it does take a few minutes each month to make sure things are in order—and too many offices let things “slip” or “fall through the cracks.”
c. The employer can assign or delegate this job to an employee, but ultimately it is the employer’s responsibility to make sure things are being done and in compliance. In many of the inspections/audits I conduct, the dentist/hygienist employer often says, “I thought it was being done. I trusted it was being done. I assumed it was being done,” when in fact it was not. - No Annual Training or Improper Annual Training
a. Training must be live and interactive, and conducted by a qualified trainer.
b. Such training must be provided at no cost to the employee and during working hours.
c. Part-time and temporary employees, and healthcare employees, known as “per diem” employees, are covered and are also to be trained on company time. - Compliance Manual and Record Keeping
a. It is required that all offices have a compliance manual that is up-to-date and complete. A dusty binder on an office shelf isn’t a useful resource for the office nor will it protect you should you have to produce records.
b. Maintaining a compliance manual does not take that much time, but it does require someone paying attention. Employers should assign someone to oversee it, make sure a system is in place and provide dedicated time for this task. - Weekly Spore Testing
a. Weekly spore testing is a very important topic and one that the Colorado Dental Board takes seriously. This is one of the most important things we do as dental professionals to ensure patient safety.
b. Most everyone will tell you they are spore testing weekly, but the actual electronic reports often tell a different story. For example, take a calendar and circle each day the report says a spore test was conducted. Next, create a summary of your results that include:
i. Total weeks in calendar (excluding vacation weeks when office is closed)
ii. Total spore tests conducted
iii. Total weeks with spore testing
iv. Longest period with NO testing
v. Best weekly consistency
vi. How did you do? Any holes? Gaps? Concerns? - Lab Coats
a. All staff with patient contact must wear protective attire. Scrub tops are NOT adequate protective attire, nor are short sleeve scrub tops with a long sleeve shirt under the scrub top.
b. Everyone (which includes all dentists, assistants and hygienists) must wear a lab coat while treating patients who are in a supine position.
c. The lab coat must be long sleeved and fall below the waist so the coat can cover the provider’s upper thighs while seated.
d. The lab coat must snap or zip so that it can be removed without having to pull it over the head.
e. Allowing employees to take their lab coats home to launder is an infection control violation.
What one thing do you see today that concerns you most?
I’m concerned about the effect social media (i.e. Facebook, Twitter, Instagram) has had on dental professionals who use it as a source or means of information. Not only are many of the answers/responses to questions incorrect, they are also incriminating. Folks need to remember that anything posted on social media can be used as evidence against you in a court of law. I encourage everyone to use reliable sources for their information, NOT social media.
Why do you do this? What makes it rewarding?
Patient and practitioner safety is paramount for all of us in dentistry. I started doing this 30 years ago with hopes of helping offices understand and manage the issues surrounding disease transmission, infection control and the occupational hazards we face every day. Along the way, the dental friends and relationships I’ve developed make everything even more special. I’d like to thank Dr. Jay Heil (d. January 28, 2008) who I miss dearly and Dr. Gene Bloom for believing in me and helping me launch my business. I still have all my seminar attendance records going back to 1990 and many folks have attended my seminars every year for 30 years. I feel blessed and grateful that I’ve been able to “practice what I preach” and help so many offices with their goal of being compliant along the way. It’s been a great ride and the road ahead looks even brighter.
Kim Laudenslager, R.D.H. offers over 25 courses each year for dental professionals. Learn more or contact her by visiting kimlaudenslager.com.