Disclaimer: Facts are based upon an actual OSHA investigation.  This case is presented for educational purposes only and does not constitute legal advice or a legal opinion.

Mishandling of employee needlestick injury

Areas of Impact:

Regulatory Compliance; Employee Safety

Case Summary:

A New Hampshire dental office was cited by OSHA for alleged willful and serious violations of occupational health standards after an employee suffered a needlestick injury. The office faced $76,500 in proposed fines.

Circumstances of the Case:

The OSHA inspector found that the office did not follow the post exposure follow-up requirements as outlined in the Bloodborne Pathogens Standard. The injured employee was not provided with a no-cost, post-exposure medical evaluation and follow-up, nor was the blood of the source individual tested, as required.

In addition, the office's training program did not include the proper method of removing the capped needle from a syringe, did not explain procedures to be followed in the event of an exposure and did not provide an opportunity for employees to ask questions about the training. The office's exposure control program also was incomplete and not updated annually. Finally, the office did not use needles with engineered safety devices for user protection.

Outcome of the Case:

OSHA issued one willful citation, with a $63,000 proposed fine, for not testing the source individual's blood for infection even after OSHA notified the office that this was required. OSHA defines a willful violation as one committed with plain indifference to or intentional disregard for employee safety and health.

Six serious citations, with $13,500 in proposed fines, were issued for not providing the post-exposure evaluation and follow-up; not annually reviewing and updating the exposure control program; training deficiencies; and not using sharps with engineered sharps protection. A serious citation is issued when death or serious physical harm is likely to result from a hazard about which the employer knew or should have known.

What could have been done differently?

Hint: Review OSHA Module III, Lesson V

Risk Management Take-Aways:

• OSHA’s regulations apply to dental offices of all sizes; ignorance of the laws or willful noncompliance are not tolerated by regulators.
• The post exposure follow-up procedures clearly mandate that the source individual's (patient) blood be tested as soon as feasible and after consent is obtained in order to determine HBV and HIV infectivity. However, section 1910.1030(f)(3)(ii)(A) of the Bloodborne Pathogens Standard (BBP) does not address situations when the patient declines to be tested. It would be wise to document attempts to ask the patient as well as the patient’s response.
• The Needlestick Safety and Prevention Act of 2000 (NSPA) strengthened the BBP standard requiring the implementation of safety measures in workplaces where there is occupational exposure to blood or other potentially infectious materials (OPIM). Under the standard, as revised by the NSPA, employers are required to evaluate, select, and implement engineering controls (e.g., sharps with engineered sharps injury protections or needleless systems) to eliminate or minimize exposure to contaminated sharps [29 CFR 1910.1030(d)(2)(i)]. In this case engineered safety devices were not being used.
• The BBP requires that your exposure control program be reviewed and updated annually. Do you have documentation that your program is reviewed annually?
• The BBP requires annual training and specifies what topics must be included. OSHA interprets annual training as once every 365 days and not once in a calendar year. One of the specific requirements of OSHA training is the opportunity for employees to ask questions about the training.

Case Source:

https://www.osha.gov/news/newsreleases/region1/09222008