CLINIC SAFETY & COMPLIANCE 2016

1. CLINICSAFETY & COMPLIANCE2016

2. TRAINING REQUIREMENTS • All Doctors, Clinic Managers, District Managers, clinic employees, and Home Office employees who visit the clinics, must receive the OSHA Bloodborne Pathogen DVD training along with this power point and the OSHA competency test.

3. EMPLOYEE HEALTH & SAFETY It is the goal of Ocean Dental to provide a completely safe workplace for every one of our employees If you experience or witness an accident in which an employee, patient or visitor sustains a personal injury, regardless of how serious, immediately report the situation to your manager and the Compliance Coordinator Employees who are exposed to occupational health hazards or suffer a job-related injury must report it immediately to the HR Coordinator. Non job-related injuries that might be aggravated on the job or adversely affect job performance are also to be reported

4. ARRIVING & DEPARTING THE BUILDING It is the desire of Ocean Dental Corporate that the manager of each office be the first one to enter the building and the last one to leave the building. When the situation arises to where the manager will not be able to fulfill this duty, the Manager’s designee will be held responsible in place of the manager.

5. ARRIVING AT THE BUILDING Check the outside grounds for litter Check the doors and windows for breakage Unlock the door Type in the correct security code to deactivate the alarm Relock the door if you feel it is necessary for your safety Check to make sure everything is in order as you left it Begin your normal business day

6. DEPARTING THE BUILDING Make sure that everything on the end of the day checklist has been completed Make sure all necessary equipment has been turned off Make sure that all patients, parents and employees have left the building Turn off all lights and TV’s Gather all personal belongings Type in the correct security code to activate the alarm Quickly and carefully leave the building Lock the door Double check to make sure the door is locked

7. OSHA GUIDELINES

8. BLOODBORNE PATHOGENS Including but not limited to: • Hepatitis B *Hepatitis B is the only one with a vaccination *Hepatitis B can remain infectious on environmental surfaces for up to 7 days at room temperature • Hepatitis C • HIV

9. BLOODBORNE PATHOGENS – MODES OF TRANSMISSION Bloodborne viruses such as hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) • Direct contact with blood or body fluids • Indirect contact with a contaminated instrument or surface • Contact of mucosa of the eyes, nose, or mouth with droplets or spatter • Are transmissible in health care settings • Can produce chronic infection • Are often carried by persons unaware of their infection

10. HEPATITIS B VACCINATION Free to all employees at risk for exposure Employer pays May decline but must sign declination (except Ohio) Medical evaluation 3 shots over 6 months Titer 1-2 months after 3rd shot If titer is low, repeat series and titer If titer still low, seek medical evaluation Employee pays Documentation must be kept for 30 years beyond termination Shot records, lab report, or declination

11. Place the cap on a hard, flat surface; then move your hand away from the cap. With one hand, hold the syringe and use the needle to “scoop-up” the cap. When the cap covers the needle tip completely, hold the needle at the base near the hub and use the other hand to secure the cap. ONE-HANDED ‘SCOOP’ TECHNIQUE

12. FIRST AID FOR EXPOSURES Treat exposures as medical emergencies – tend to them IMMEDIATELY 1. Clean wound with soap and water. In the case of a mucous membrane exposure, flush the affected area with cool water. 2. Report the injury to your manager IMMEDIATELY. Provide as much information about the incident as you can. 3. Follow instructions for obtaining immediate and appropriate medical evaluation and follow-up care.

13. POST-EXPOSURE EVALUATION AND FOLLOW-UP Offered immediately Free of charge to exposed employee Confidential Under the supervision of a licensed healthcare provider Informed consent is required for HIV testing Exposed employee may decline testing, or may have blood collected and preserved for up to 90 days before making a final decision Source individual’s test results are given to the exposed employee with confidentiality cautions to protect the source individual

14. HANDS NEED TO BE CLEANED WHEN…. Visibly dirty After touching contaminated objects with bare hands Before and after patient treatment (before glove placement and after glove removal) Before & after breaks, lunch and using the restroom

15. HAND HYGIENE CONSIDERATIONS Use hand lotions to prevent skin dryness (non-petroleum based) – ONLY those hand soaps and lotions approved by Ocean Dental are to be used Consider compatibility of hand care products with gloves (e.g., mineral oils and petroleum bases may cause early glove failure) Keep fingernails short (no more than ¼ inch) No artificial nails, chipped nail polish or nail jewelry in direct patient care areas Avoid hand jewelry that may tear gloves

16. PROTECTIVE CLOTHING Wear gowns, lab coats, or uniforms that cover skin and personal clothing likely to become soiled with blood, saliva, or infectious material Lab coat sleeves are not to be pushed up exposing arms Change if visibly soiled Employees may only wear the PPE provided by the employer – NO cloth lab coats. Employees are not allowed to take lab coats home to launder Maintained and/or replaced by the employer NO CROCS, CLOGS OR OPEN TOESHOES – FEET MUST BE COMPLETELY COVERED

17. PROTECTIVE CLOTHING • Remove all barriers before leaving the work area • Masks, gloves and protective eyewear are to be removed before leaving the operatory • Masks are not to be worn under the chin • Eyewear is not to be worn on top of the head – they are contaminated and must be removed and disinfected between patients • Lab coats are not to be worn in the break room or the restroom • Rx glasses can be worn, but need to have a face shield or protective eyewear over them

18. REMOMMENDATIONS FOR GLOVING Remove gloves that are torn, cut or punctured Do not wash, disinfect or sterilize gloves for reuse

19. GENERAL RECOMMENDATIONS FOR CONTACT DERMATITIS AND LATEX ALLERGY Educate DHCP about reactions associated with frequent hand hygiene and glove use Get a medical diagnosis Screen patients for latex allergy Ensure a latex-safe environment Have latex-free kits available (dental and emergency)

20. TRANSPORTING CONTAMINATED INSTRUMENTS • Ocean Dental provides locked containers for the safe transfer of contaminated dental instruments. • Contaminated instruments will only be transferred from the operatories to the sterilization/lab area using the locked containers. • Once the locked container is placed in the sterilization/lab area the employee must wear the provided utility gloves to open the container and clean the instruments. • The container and lid must be properly disinfected before it is returned to the operatory for use.

21. PREPARATION AND PACKAGING Items that will be stored should be wrapped or placed in containers before heat sterilization Hinged instruments opened and unlocked Place a chemical indicator inside the pack or use bags that have the chemical indicator strip Wear heavy-duty, puncture-resistant utility gloves when handling contaminated sharp instruments

22. PROPER PPE IN THE LAB / STERILIZATION • PPE (gown, gloves, mask, eye protection) must be worn when working in the lab • Preparing, disinfecting, packaging models • Cleaning and bagging instruments • Wear heavy-duty, puncture-resistant utility gloves when handling contaminated sharp instruments • Cleaning environmental surfaces • Refilling materials

23. STERILIZATION MONITORING Types of Indicators Mechanical Measure time, temperature, pressure Chemical Change in color when physical parameter is reached Biological (spore tests) Use biological spores to assess the sterilization process directly Must be tested weekly – notebook is in the lab Biological monitoring website must be checked regularly for test results Sterilizers must run the complete cycle, including dry time, for the sterilization process to be complete If a sterilizer is opened before the cycle is complete, the sterilizer must be restarted

24. STORAGE OF STERILE AND CLEAN ITEMS Use date-or event-related shelf-life practices – All sterilization packs must be dated and indicate which sterilizer was used Examine wrapped items carefully prior to use When packaging of sterile items is damaged, re-clean, re-wrap, and re-sterilize Sterilized bags are to be left paper side down to dry completely Store clean items in dry, closed, or covered container Sterilized instruments are to remain bagged until ready for patient use

25. BIOHAZARDOUS WASTE Discard these items into biohazardous waste containers (red bags): □ Gloves, masks or lab coats – if visibly contaminated □ Saturated or caked absorbent materials (gauze, bandages, etc) □ Liquid or semi-liquid blood or other potentially infectious materials

26. CLEANING HOUSEKEEPING SURFACES Routinely clean with soap and water or an EPA-registered detergent/hospital disinfectant routinely Clean mops and cloths and allow to dry thoroughly before re-using Prepare fresh cleaning and disinfecting solutions daily and per manufacturer recommendations Periodically inspect waste containers and clean as needed Change barriers in operatories between each patient. EE must wear PPE to change barriers and when cleaning surfaces. Air/water syringe heads must be flushed between each patient (syringe tips must be changed between each patient)

27. DENTAL LABORATORY Clean and disinfect prostheses and impressions Wear appropriate PPE until disinfection has been completed Clean and heat sterilize heat-tolerant items used in the mouth or use disposable items Communicate specific information about disinfection procedures – label bag being sent to lab with the disinfectant used

28. FOOD & DRINK OSHA guidelines – Ocean Dental Policy Food & Drink is allowed in the break room ABSLOUTELY NO food & drink allowed in operatories and hygiene Exception: drinks with lids are allowed at front desk and in doctor/manager offices

29. EVACUATION PROCEDURES Fire, gas leak, bomb threat Notify all employees Call 911 Business staff: assist co-workers and anyone in the reception area Clinical staff: assist co-workers and anyone in the patient care areas Exit through the nearest unobstructed exit Meet at designated place Check in with Manager, stay put

30. EXTINGUISHING THE FIRE Remove the extinguisher from the bracket Break the seal and remove the pin Aim the nozzle at the base of the fire, starting 8-10 feet back and using a sweeping motion

31. EARTHQUAKE SAFETY (OKLAHOMA) • Drop to the ground and take cover by getting under a sturdy table or piece of furniture. If there is not a table or desk near you, cover your face and head with your arms and crouch in an inside corner of the building. Avoid glass, windows, and outside walls/doors. • Do not exit the building until after the shaking stops. Once the shaking stops, look around the clinic and once you determine it is safe to move, exit the building and report to the assigned evacuation location. Do not leave the assigned evacuation area or re-enter the building unless instructed by the Practice Manager. • In the event of fire, flooding, injured or missing persons call 911 immediately.

32. SAFETY DATA SHEETSSDS Employer is required to have SDS available for every hazardous chemical or substance you use or encounter as a part of your job SDS must be readily available for employee review at all times you are in the work place…They can not be locked in an office or filing cabinet to which you do not have access to. THE SDS BOOK IS KEPT IN THE LAB NEAR THE EYEWASH STATION

33. HAZARDOUS COMMUNICATIONS • SDS sheets are not required for office supplies or cleaning supplies that are used in the clinic as they are in a residential setting. • SDS sheets contain information on flammability and what to do in case of a spill

34. NITROUS AND OXYGEN TANKS • The storage closet for the nitrous and oxygen tanks must remain locked. The office manager and/or clinical coordinator will be responsible for the key • The tanks are to be upright and secured at all times • The tanks are to be labeled according to Materials Management guidelines (full/empty/in use)

35. Disposal of Amalgam & Amalgam Contaminated Items • All amalgam waste and amalgam contaminated items must be disposed of and stored properly. • Amalgon 1 Containers • To be stored in the lab • Must be replaced when full or every 12 months, whichever comes first • Prior to disposing of containers, order a new container through Materials Management • Follow manufacturer guidelines for proper packaging and shipping • Items to be placed in recycling container • chair-side traps • Screens • Capsules (empty or not) • Dispose a bowl traps (for those clinics that have wet vacs) • scrap amalgam • amalgam contaminated teeth • http://wastewise.com/products/amalgon/

36. Amalgam Separators – CLEVELAND ONLY Amalgam separators are installed according to manufacturer guidelines. Amalgam separator filters are to be changed and properly disposed of only by Schein technicians and/or authorized personnel following manufacturer guidelines. Amalgam filters and Wavicide 06 disinfectant are to be ordered through Materials prior to service calls.

37. EYEWASH STATION Must have one if you have any chemical that could be hazardous to the eyes Avoid bacterial contamination EYEWASH STATION IS IN THE LAB/STERILIZATION AREA

38. TUBERCULOSIS Airborne, spread through droplet nuclei released when infected individual coughs Symptoms of active disease: Productive cough, longer than 3 weeks Coughing up blood Night sweats Fatigue Weight loss, anorexia Fever

39. BACK SAFETY When lifting: Plan what you want to lift and don’t be in a hurry Separate your feet one shoulder width apart to give you a solid base of support Bend at your knees, not at the waist Keep your back straight Avoid twisting your body and point your toes in the direction you want to move Lift with your legs, not your back

40. BACK SAFETY • The KEY to lifting safely is keeping your back straight or slightly arched. NEVER USE YOUR BACK TO LIFT! • Squat down like a professional weightlifter, bending your knees. Keep your back straight or slightly arched. You want your legs to do the lifting, not your back. • Start the lift by putting your feet close to the object. • Center your body over your feet. • Grasp the load securely with your hands, and pull the load close to you. • Smoothly lift straight up. NEVER TWIST YOUR BODY WHILE LIFTING, KEEPING YOUR HEAD UP, AS IF LOOKING STRAIGHT AHEAD, NOT DOWN.

41. ICE & SNOW • Many cold-weather injuries are the result of falls on ice-covered streets and sidewalks. • Getting around in icy conditions calls for planning, caution, and a little common sense. • Dress warmly and wear boots with non-skid soles. (Avoid plastic and leather soles.)

42. ICE & SNOW • No matter how well the ice & snow are removed from streets & sidewalks, people will encounter slippery surfaces when walking outdoors in the winter.

43. HOW TO WALK • Be prepared to fall and try to avoid using your arms to break your fall. • If you fall backward, make a conscious effort to tuck your chin so your head won’t hit the ground with full force. • When entering a building, remove as much snow and water from your boots as you can. • Notice that floors and stairs may be wet & slippery—walk carefully.

44. HOW TO WALK • Pay attention to your surroundings • Look where you are going when you walk • Do not read, text or dial while you are walking

45. SLIPS, TRIPS & FALLS • Damaged, warped, buckled, or uneven flooring surfaces inside healthcare facilities can cause employees to stumble, trip, slip, or fall

46. Clutter can build up in storage areas, work areas, hallways, and walkways potentially leading to a slip, trip, or fall incident. Exposed cords on the floor, stretched across walkways, and tangled near work spaces can catch an employee’s foot and lead to a trip and fall incident Wet floors must be marked with a Caution sign.

47. Close your desk, cabinets and file drawers immediately after each use Keep the floor to your workspace free of boxes, cords, materials, cables and objects OFFICE SAFETY

48. Always use the handrails when climbing or descending stairs Do not rush or skip steps Don’t carry anything that will compromise your ability to see or hold on to the handrails STAIR SAFETY

49. See a Potential Hazard? Report It Immediately!

50. DRIVER SAFETY POLICY Employees who are required to drive on company business will be expected to consistently follow the procedures below. • All employees must wear seat belts at all time while in a moving vehicle during company business, whether they are the driver or a passenger. • While driving during company business or for a company related purpose, no employee, other than in an emergency situation shall operate an electronic device (cell phone, Blackberry, iPod, iPhone, computer, GPS, etc.) while the vehicle is in motion. • Engaging in other distracting activities including, but not limited to, eating, putting on makeup, reading or changing radio stations or music, is also strongly discouraged while driving. • The use of alcohol, drugs or other substances, including over-the-counter medications that impair driving ability, is prohibited. • All employees are expected to follow all driving laws and safety rules. Employees must avoid confrontational or offensive behavior while driving. • Employees may not allow anyone to ride in any part of the vehicle not specifically intended for passenger use and/or any seat that does not include a working seat belt. • Employees must promptly report any accidents to local law enforcement as well as to the company in accordance with established procedures. • Employees are also expected to report any moving or parking violations received while driving on company business and/or in company vehicles.