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In our current climate, it’s easy to take for granted the attention given to making the dental practice a safe environment. Looking back, however, it becomes clear that, not long ago, far less emphasis was placed on dental safety.
In contrast with other healthcare settings such as hospitals, safety in dentistry was historically considered a secondary priority. This can be attributed to several factors, namely that, relative to medicine, dental care has generally been subject to less regulatory oversight due to lower perceived risk. As researchers have noted, “human error in the dental environment” was assumed to produce far less “morbidity, mortality and financial impact” compared to errors made in medicine.
Unfortunately, a lax attitude toward creating safe conditions in dentistry has led to several highly publicized incidents that resulted in infection, injury and even death among dental patients and staff. Likewise, involved practices faced extensive investigation by health officials and, ultimately, serious legal and financial repercussions.
In each of the reported incidents, investigators noted a failure to adhere to the safety standards set by the Centers for Disease Control and Prevention (CDC). Breach examples include improper instrument sterilization, lack of dental unit waterline maintenance, unsafe injection practices, inadequate infection prevention training and oversight, and more.
A single lapse in safety can cost practices immensely in terms of both production and profits, but it also puts the business’s reputation and legal security on the line. Conversely, developing a practice-wide culture of safety has proved to improve treatment outcomes, boost patient and employee satisfaction, enhance practice reputation and protect against litigation.
Defining a culture of safety in the dental setting
Safety culture can be understood, as Kandis V. Garland, RDH, MS, states, as “the manner in which safety is managed in the workplace,” often reflecting “the attitude, beliefs, perceptions, values and behaviors that employees share in relation to safety.”
A mutual sense of ethical responsibility comprises the core of safety culture, as seen in a study of U.S. hygienists that revealed that higher compliance with CDC guidelines was shown when employees genuinely believe that safety is important. Study participants reported that other perceived barriers to compliance included a lack of time, knowledge, training, and, above all, support and guidance from practice leadership.
A top-down approach to infection prevention
The above findings show that, while it takes a group effort to maintain safe practice conditions, creating a culture of safety starts at the top. As hygienist and infection prevention expert Mary Govoni, MBA, RDH, CDA, explains, “the doctor/owner must believe that safety is vital to the success of the practice and safety must be woven into the culture or value system of the practice.”
When leadership is clear and consistent in communicating the importance of safety and employers visibly model safe behavior for employees, it sets a standard that everyone in the organization is more likely to meet. Garland notes that other leadership responsibilities in safety culture-building include setting benchmarks and monitoring progress, facilitating training, establishing systems for accountability and providing performance feedback.
The dental safety officer and infection control coordinator
To ensure oversight during daily operations, dentists and other practice heads can delegate responsibility to roles outlined by the CDC and Occupational Safety and Health Administration (OSHA). Since its formation in 1970, OSHA has issued regulations instrumental to fostering safety culture in the workplace and drastically reducing on-the-job injury, illness and death.
Thanks in large part to its efforts, reported worker injuries and illnesses have fallen from 10.9 incidents per 100 workers in 1972 to just 2.7 per 100 in 2020 (despite an increase in illnesses due to the COVID-19 pandemic). Compliance with OSHA mandates means dental practices are required to appoint a safety officer: a person (or persons) officially named in written safety plans and tasked with implementing and overseeing safety programs that fall under the OSHA Hazard Communication Standard and Bloodborne Pathogens Standard.
While a practice’s OSHA safety officer is largely focused on worker protection, the CDC’s 2016 Summary of Infection Prevention Practices in Dental Settings also advises that practices name an infection control coordinator (ICC). This role is responsible for designing and overseeing the office’s infection control program along with enacting and enforcing policies that maximize both patient and staff safety.
When it comes to selecting a safety officer and ICC, dental practices have a good deal of flexibility. As Govoni explains, “the same team member can serve as the OSHA safety officer and the infection control coordinator, the tasks can be assigned to several team members or a safety committee can be formed within the practice.”
Regardless of who is chosen for these roles, Govoni notes that all parties should display “great attention to detail” and “a high level of interest in infection prevention and safety.” Additionally, both positions require a willingness to undergo advanced training as well as develop, document and disseminate practice safety and infection control policies and protocols (usually in addition to performing regular clinical or administrative duties within the practice).
Many resources for training safety officers and ICCs are available online, as are guides and templates that assist with program and policy creation. They can be found on the CDC, OSHA and Organization for Safety, Asepsis and Prevention websites. Practices also may consider hiring an outside safety or infection prevention consultant who can deliver educational presentations, objectively evaluate procedures and protocols and provide tailored guidance on improving safety measures.
Teamwork and communication
While senior leadership, safety officer and ICC are essential to getting the ball rolling and providing a framework for safety, cultivating a safe practice environment is ultimately a team sport. Safety culture can’t be imposed, and it can’t, as Govoni writes, simply be “an afterthought or an irritating regulatory obligation.”
Instead, it must grow organically from a mutual understanding of the importance of safety; a willingness to embark on a path of proactive, continued learning; and a sense of personal accountability – to patients, colleagues and the practice itself. Furthermore, teamwork and by extension, safety culture, necessitate open and honest discourse. All practice personnel should be ready to share knowledge freely and support each other in keeping up with an ever-evolving set of evidence-based standards and guidelines.
In the end, safety culture succeeds when staff members themselves feel safe, not only from risk of injury or illness, but also safe to voice mistakes, concerns and gaps in understanding without fear of blame, judgment or unwarranted punitive action. They must feel safe to try every day to better serve patients and the practice.
Products for a safer dental practice
Creating a culture of safety takes a serious commitment from the whole team. But it also requires the right tools for the job – quality products you can depend on to minimize error, improve efficiencies and reduce stress. Consult with your Patterson representative for PPE, surface barriers, disinfectants and other foundational items to help you build a culture of safety and deliver better dental care.
Bureau of Labor Statistics. Employer-reported workplace injuries and illnesses – 2020. November 3, 2021.
Centers for Disease Control and Prevention. Summary of infection prevention practices in dental settings: Basic expectations for safe care. October 2016.
Garland KV. Create a culture of safety. Dimensions of Dental Hygiene. March 10, 2016.
Govoni M. Creating a culture of safety in dental practice settings: Defining the role of the infection control coordinator. Dental Economics. February 14, 2018.
Lee L. Dental care: Patient safety is paramount. DentistryIQ. August 8, 2017.
Sammer CE, Lykens K, Singh KP, et al. What is patient safety culture? A review of the literature. J Nurs Scholarsh. 2010:42(2):156-165.
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A version of this article appears in the April edition of OnTarget. Read the latest edition and view current promotions at pattersondental.com/dental/ontarget.