Navigating Infection Control Compliance & Best Practices

By Olivia Wann

Dental compliance and infection control have become even more important to dental practices, and for good reason. Not only does adhering to protocols keep patients and staff safe, but it also virtually minimizes the risk of investigative action or complaints. We talked with Olivia Wann, founder of Modern Practice Solutions and a lawyer and compliance consultant and got her perspective on the complex landscape of dental compliance and infection control. Her combination of practical experience in the industry and legal education makes her an expert guide to dental practices wanting to bridge the gaps in their OSHA, infection control, and HIPAA compliance programs and implement effective safety training.

Can you share a little about your background and your work?  

I worked as a dental office manager and registered dental assistant for a general dentist in my hometown for many years. I later decided to be a trainer/consultant focusing on dental compliance. I earned a bachelor’s degree in health care management at St. Joseph’s College of Maine and a doctorate in jurisprudence at the Nashville School of Law. My company, Modern Practice Solutions, has been serving the regulatory needs of dental practices since 2000 through presentations, site audits, customized policies, and online/onsite training programs. While maintaining a busy consulting firm, I started my law practice, The Law Office of Olivia Wann & Associates, in 2012. I recently co-authored the ADA Guide to OSHA Compliance for Dental Offices and the ADA OSHA Training Guidance for the Dental Team. As you can see, much of my life has been spent in the dental industry. On the weekends, though, I am just a farm girl spending time with my horses, pigs, and goats.

What happens legally when a practice does not follow guidance? What are the risks involved?

When a dental practice does not follow infection control guidelines, there is the risk of facing:

• The state dental board
• OSHA
• The Department of Health
• A potential plaintiff in a malpractice action

Can you walk us through the investigative process of violations/complaints? 

State Dental Board: Here is my experience of working with dental board complaints in Tennessee. States may vary in their exact process. If a complaint is filed against a dentist, the board notifies the dentist by letter, a telephone call, or a site visit from a board investigator. The dentist may hire an attorney to be present, which I highly suggest. Keep in mind that the investigator interviews the staff members individually to gather information. The board presents a Consent Order for the dentist to review and sign. This order waives the right to a contested case hearing. There are Stipulations of Fact and Grounds for Discipline in addition to a Policy Statement and Order. The Order contains the reprimand and the discipline. For example, if this was an infection control issue, the dentist may be ordered to prepare an infection control plan in addition to satisfying a certain number of CEs in the area of infection control. A civil monetary penalty may be imposed.

OSHA: OSHA evaluates complaints to determine whether an offsite or onsite investigation is warranted. OSHA’s top priority in making an investigation is imminent danger. Needlesticks improperly handled rise to this level. If you receive a letter from OSHA, you have only five days to respond. If OSHA feels that there is imminent danger, you may receive an unannounced visit. The inspection includes an opening conference, a “walkaround” of the workplace, and a closing conference. What may have been a single allegation of a complaint could result in multiple violations noted during the site visit.

The Department of Health: The states maintain a Department of Health. For example, in Tennessee, the Department of Health – Health Related Boards maintains a complaint hotline. Upon receipt of a complaint, the complaint is prioritized and forwarded to the appropriate office for further investigation. If there is sufficient evidence, the Department can impose deficiency citations or penalties.

Lawsuit: A dental office may be subject to a malpractice action due to an infection control breach. The patient retains a lawyer, and a civil suit may end up filed in court. Your records would be subpoenaed, including your infection control plan and task logs. Even your dental supply order histories may end up in court. Your staff members may be called as witnesses. Most cases are settled out of court, with the dentist making a monetary settlement.

How can practices implement effective infection control plans and safety training? What are some best practices? 

Dental practices can implement effective infection control plans by aligning their processes with the latest guidelines published by the CDC. This involves an honest evaluation of what is currently in place versus what is missing. — everything from surface disinfection to maintaining waterline quality. Safety training should include not only the OSHA-required bloodborne pathogens training but also infection control and prevention training. A good place to start is to use CDC’s Infection Prevention Checklist for Dental Settings Basic Expectations for Safe Care.1 You can either access the web version or use the app. Go through your dental practice as if you are a neutral third party and honestly and accurately assess the level of adherence to the elements to be assessed and note any areas for improvement. I find it helpful to take photos, which I actually incorporate into our firm’s checklist — including both infection control and prevention and OSHA compliance. You can create a similar report using the CDC’s checklist and a compilation of your photos.

Create your infection control and prevention plan. You can start with a template or utilize HuFriedyGroup’s
GreenLight Program.2 Be very specific when detailing your processes to include the product(s) in use. For
example, if you are addressing water quality protocols, list the product(s) in use and how to use it. In this
manner, we minimize the risk of error.

We suggest incorporating a quality control system. This can be as simple as a task sheet generated using Google Docs or Word or, for larger practices, utilizing a software program. For example, on the topic of water monitoring, detail in your task log when the tests were conducted, the initials or signature of the person conducting the tests, the results, and a brief narrative of how you responded to a failed test. 

What are some important resources to call out? ​

What I have learned over my dental compliance consulting career as well as my journey as a lawyer is that you must affiliate yourself with professional groups that can grow your knowledge and expertise. Hands down, join OSAP. OSAP’s annual Boot Camp and symposium is critical to keep your skills current. There is also great value to reading the newsletter each week and accessing the Frequently Asked Questions on their website (https://osap.org). It is also invaluable to pursue certification in Dental Infection Prevention and Control (DIPC), Dental Industry Specialist in Infection Prevention and Control (DISIPC), and Dental Infection Prevention and Control (CDIPC).

Additionally, I suggest becoming very familiar with the CDC’s website (https://www.cdc.gov/) and staying in tune with the latest guidance for dental practices. There are also other valuable resources, such as HuFriedyGroup’s GreenLight Dental Compliance Center.2 This is a great way to manage all your infection prevention guidelines in a portal.

Last, I encourage folks to sign up for my bimonthly newsletter (https://www.oliviawann.com/newsletter). This gives me a way to inform readers of what I see personally taking place in the country as well as touch on common support topics that are flowing through my office.

In summary, now is a great time to be a part of dental infection control and align ourselves with industry giants. Our goal is to keep our practices in compliance and design a long, healthy career in dentistry.

We want to thank Olivia Wann for answering our questions, and we invite you to evaluate our safety and protection solutions. For more information, visit palmerohealth.com, call 800-344-6424 or email [email protected].

References

• CDC’s Infection Prevention Checklist for Dental Settings Basic Expectations for Safe Care. https://www.cdc.gov/oralhealth/infectioncontrol/pdf/safe-care-checklist.pdf
• HuFriedyGroup GreenLight Compliance Center. https://www.hufriedygroup.com/en/greenlight