most current state dental board mandates. It should be noted that, with the arrival of the SARS-CoV-2 (COVID-19) pandemic, infection control has expanded to the outer office, with the advent of initial patient screening and patient masking. In the operatory, use of N95 masks and face shields became more of a standard practice (Kane, 2021). As has always been the case, it is important to follow guidelines, prescribed practices, and legal requirements. health outcomes. Addressing implicit bias in healthcare is crucial for achieving equity in medical treatment. Strategies to combat these biases involve education and awareness programs for healthcare professionals. These programs help individuals recognize and acknowledge their biases, fostering a more empathetic and unbiased approach to patient care. Additionally, implementing policies and procedures prioritizing equitable treatment for all patients can play a pivotal role in reducing healthcare disparities. Ultimately, confronting implicit bias in healthcare is essential to creating a more just and equitable healthcare system where everyone receives fair and equal treatment regardless of their background or characteristics.
comprehensive infection control program. State regulations are reviewed regularly to ensure that they reflect the current state of knowledge and to assure optimum levels of safety for both healthcare personnel and patients. California dental healthcare personnel (DHCP) should check the Dental Board of California website regularly for any changes or updates to these regulations. A thorough working knowledge of these regulations provides patient and DHCP safety, and assurance that the dental office is in compliance with the professionals perceive and make treatment decisions, ultimately resulting in disparities in health outcomes. These biases, often unconscious and unintentional, can shape behavior and produce differences in medical care along various lines, including race, ethnicity, gender identity, sexual orientation, age, and socioeconomic status. Healthcare disparities stemming from implicit bias can manifest in several ways. For example, a healthcare provider might unconsciously give less attention to a patient Implicit bias in healthcare Implicit bias significantly affects how healthcare or make assumptions about their medical needs based on race, gender, or age. The unconscious assumptions can lead to delayed or inadequate care, misdiagnoses, or inappropriate treatments, all of which can adversely impact
FEDERAL REGULATIONS
Occupational Safety and Health Administration With the advent of the Bloodborne Pathogens Standard [29 C.F.R. §1910.1030 (1992)], OSHA began requiring healthcare employers, including those in the dental profession to limit occupational exposure of employees to blood and other potentially infectious materials. With the emergence of HIV and the documentation that this disease was efficiently spread by contact with blood and blood products, concern about the spread of this infection in all healthcare settings began to emerge. Toward the latter part of the 1980s, there was sufficient evidence to conclude that certain health risks were associated with exposure to body fluids containing pathogenic organisms, including HIV, HBV, and HCV (CDC, 2020; CDC 2016b). Before this time, little effort was directed at eliminating or even minimizing exposure from needle sticks and other sharps. (A sharp is any object that can penetrate the skin, including, but not limited to, needles, scalpels, broken glass, broken capillary tubes, and other objects.) With the introduction of the Bloodborne Pathogens Standard in 1992, OSHA required employers to reduce or eliminate the hazards for any employees with occupational exposure (i.e., exposure to blood or to other potentially infectious material [OPIM] while performing their jobs) (OSHA, 2001). OSHA began to require each health care facility to have an exposure control plan that provides a detailed description of how to reduce or eliminate occupational hazards. Included in the exposure control plan is a requirement to implement engineering controls (devices that isolate or remove the BBP hazard) and work practice controls (practices that reduce the likelihood of exposure by changing the way a task is performed). The exposure control plan should also include identification of job categories that involve exposure to potentially infectious materials (e.g., blood and saliva); the type and indications for the use of personal protective equipment (PPE); BBP training; exposure prevention and post-exposure management strategies; and providing HBV vaccinations for all employees with occupational exposure. Separate OSHA regulations address other safety- related items such as signs on exits, fire extinguishers, and additional safety equipment; and labels on products and chemicals used in the dental office.
In April of 2001, the Bloodborne Pathogens Standard was revised to include the Needlestick Safety and Prevention Act. This revision by OSHA required employers to include provisions to eliminate or minimize employee exposure to sharps and occupational exposures in the exposure control plan. More specifically, each employer must review the latest technological changes (e.g., self-sheathing needles and scalpels) and decide whether to incorporate them into their practice. This review must be done on at least an annual basis and must include employee input. The decision to incorporate such devices into their practices is made by the clinicians using the specific devices. Decisions about whether to incorporate such devices into the practice cannot be based solely on the criterion of cost. One important aspect of the Bloodborne Pathogens Standard was the required use of universal precautions, which later evolved into the standard precautions that are practiced today. Standard precautions include major components of both universal precautions and body substance isolation precautions. Standard precautions apply to all body fluids, excretions, and secretions (with the exception of sweat) and should be observed during all patient encounters, regardless of the health status of the patient (i.e., the same way, every day, for every patient). The basic elements of the standard precautions are listed in Table 1. The OSHA Bloodborne Pathogens Standard is enforceable in every state in the U.S., and significant penalties can be levied for lack of compliance. Roughly half the states in the country have state OSHA programs, which are independent agencies that adopt and enforce their own Bloodborne Pathogens Standard. The federal Bloodborne Pathogens Rule serves as the minimum standard, and some states have expanded the regulation to include requirements not found in the federal rule. Each dentist/employer must be compliant with all the elements of the Bloodborne Pathogens Standard, including: ● Establishing an exposure control plan designed to protect employees with occupational exposure from contacting blood and OPIM.
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