The U.S. Department of Labor’s Occupational Safety and Health Administration (OSHA) was established in 1970 to ensure safe and healthful working conditions for workers by setting and enforcing standards and by providing training, outreach, education and assistance.[1] Many standards apply to dental settings as part of the greater healthcare team and compliance is vital to team member safety. On June 10, 2021, OSHA issued a new “emergency temporary standard” (ETS) to protect healthcare workers from contracting coronavirus, and it became effective when it was published on June 21, 2021. Just what everyone wants – another standard from OSHA to comply with! Let’s look at what it means for dentistry.

1. What is OSHA’s new ETS and why was it issued?

The OSHA ETS standard focuses on healthcare workers most likely to have contact with someone infected with coronavirus. OSHA announced the new standard alongside new general industry guidance, both of which are aligned with Centers for Disease Control and Prevention (CDC) guidance. The ETS establishes new requirements for settings where employees provide healthcare or health care support services, with some exemptions for healthcare providers who screen out patients who may have COVID-19. OSHA will update the standard, if necessary, to align with CDC guidelines and changes in the pandemic.[2] 

This 900-page new standard is aimed at protecting workers facing the highest coronavirus hazards—those working in healthcare settings where suspected or confirmed coronavirus patients may be treated and lists an abundance of requirements. This includes employees in hospitals, nursing homes and assisted living facilities, emergency responders, home health care workers and employees in ambulatory care settings where suspected or confirmed coronavirus patients are treated.[2]

2. Are dental practices required to comply with the provisions of the ETS?

OSHA has an excellent flow-chart that provides questions to determine if the healthcare workplace is covered by the ETS.[3]

In most cases, dental practices are exempt from compliance with the ETS as the answers to the first two questions would likely be “yes.” However, dental offices that reside in hospitals or ambulatory centers, such as hospital-based oral surgery practices or those who provide care to COVID-19 patients will be required to comply with this standard.4 Nevertheless, for all other dental practice settings to remain exempt, there are definitive requirements that must be carried out.  ‍

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3.What are the provisions or requirements of the ETS for a dental practice to remain exempt?

There are four main requirements for dental practices to remain exempt from the ETS. They are as follows:

a. Pre-appointment screenings of all patients are still necessary (via Covid-19 questions/questionnaire).
This is done to screen out patients with suspected or confirmed COVID-19, reappointing them if possible or referring them as necessary. Practices do not need to have patients complete a written screening form, rather, one strategy is to have a patient screening form in a plastic sleeve at the reception/check-in desk and ask the patient to review the questions. Then, a simple entry into the chart could be, “COVID-19 screening complete – negative.” ADA also has a sample Patient Screening Form in the Return-to-Work Interim Guidance Toolkit.[3],[5]

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b. Everyone (patients, non-employees on site/visitors and staff) must be screening prior to entry, and those with suspected or confirmed COVID-19 are not permitted to enter.
In the early days of COVID-19, many practices utilized the COVID-19 Daily Screening Log from the ADA’s Return to Work Interim Guidance Toolkit for recording staff screenings. This log would still be an efficient method to document staff screenings, however according to the ETS, screening may be conducted by asking employees to self-monitor before reporting to work as well.[3],[5]

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c. Exempt dental practices cannot deliberately see known or suspected COVID-19 patients.
‍[3],[5] This is self-explanatory and the rationale for screening all patients. 

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d. Dental practices must have a written COVID-19 plan.
First, if the employer has more than 10 employees, the COVID-19 plan must be written.6 Even if a dental office is exempt under the ETS, OSHA’s Recommended Practices for Safety and Health Programs indicates employers should have a COVID-19 plan with a hazard assessment in place to mitigate risk to employees.[5] Regardless of practice size, a written plan is always a good strategy. The ADA COVID-19 Hazard Assessment and Checklist are excellent tools for the assessment and OSHA has a COVID-19 Plan template for practices to utilize at https://www.osha.gov/coronavirus/ets.   

Lastly, it is important to know that a state or other local regulatory body, such as DHS or health departments, may enact a more stringent standard including one that does cover dental offices.[5] Thus, it is essential to stay up to date on information from the State, the Dentistry Examining Board and the WDA on what may be happening in your jurisdiction. Although there is a new OSHA standard in place, dental practices can remain exempt by carrying out easily achieved requirements that continue to promote safety in the dental workplace against COVID-19.

References:

1. US Department of Labor Occupational Safety and Health Administration. About OSHA. Available at https://www.osha.gov/aboutosha. Accessed October 7, 2021.
2. US Department of Labor Occupational Safety and Health Administration. OSHA National News Release; June 10, 2021. Available at https://www.osha.gov/news/newsreleases/national/06102021. Accessed October 7, 2021.
3. US Department of Labor Occupational Safety and Health Administration. Is your workplace covered by the COVID-19 Healthcare ETS? Available at https://www.osha.gov/sites/default/files/publications/OSHA4125.pdf. Accessed October 7, 2021.
4. American Dental Association. Dentistry largely exempted from new COVID-19 workplace regulations. Available at https://www.ada.org/en/press-room/news-releases/2021-archives/june/dentistry-and-new-covid-19-workplace-regulations. Accessed October 7, 2021. 
5. American Dental Association. OSHA COVID-19 Healthcare Emergency Temporary Standard. Available at http://success.ada.org/~/media/CPS/Files/Articles/Toolkits/OSHA_ETS_COVID-19_Key_Points.pdf. Accessed October 7, 2021.
6. US Department of Labor Occupational Safety and Health Administration. Subpart U — COVID-19 Emergency Temporary Standard. Available at https://www.osha.gov/sites/default/files/covid-19-healthcare-ets-reg-text.pdf. Accessed October 7, 2021.