May 25, 1990

Ms. Carole Frings
Federal Agency Representative
American Dental Association
Suite 1200
1111 14th Street, N.W.
Washington, D.C. 20005

Dear Ms. Frings:

This is in further response to your letter of March 20, addressed to Deputy Assistant Secretary, Alan McMillan. You requested a clarification from the Occupational Safety and Health Administration (OSHA) as to whether orthodontic wires are considered "sharps" under OSHA Instruction [CPL 2-2.69 ("Enforcement Procedures for the Occupational Exposure to Bloodborne Pathogens")] and 29 CFR 1910.141, OSHA's sanitation standard.

Although neither OSHA nor the Centers for Disease Control (CDC) defines saliva as an infectious body fluid, the CDC has determined that "during dental procedures contamination of saliva with blood is predictable" (MMWR June 24, 1988, 37:377-382, 387-388) and therefore saliva in dental settings should be considered potentially infectious.

OSHA's concern in this matter (as opposed to the Environmental Protection Agency) is to protect employees from puncture wounds which would expose them parenterally to potentially infectious body fluids. The ends of orthodontic wires can penetrate the skin. Since their contamination with blood can reasonably be anticipated, OSHA believes that they must be classified as "sharps" under the above referenced Instruction and standard and disposed of accordingly.

In your letter you referred specifically to an inspection which occurred in Michigan. As you are aware, the State of Michigan administers its own occupational safety and health program under a plan approved and monitored by Federal OSHA. As a condition of plan approval, States must assure that they will adopt, interpret, and enforce occupational safety and health standards that are either identical to or "at least as effective" as Federal standards or requirements. Because Dr. Ponitz and other employers in Michigan must comply with the requirements of the State, he may wish to contact the Michigan Department of Public Health at the following address for more information on the State's requirements:

Ms. Raj M. Wiener Director
Michigan Department of Public Health
3423 North Logan Street
Box 30195 Lansing, Michigan 48909
Telephone: (517) 335-8022

We hope this information is helpful to you.

Sincerely,



Gerard F. Scannell
Assistant Secretary

[Corrected 10/29/02]



March 20, 1990

Mr. Alan Mc Millan
Deputy Assistant
Secretary of Labor for Occupational
Safety and Health
Department of Labor
200 Constitution Avenue, N.W.
Room S2315
Washington, D.C. 20210

Re: Clarification of Definition of "Sharps" Under OSHA Instruction 2-2.44A

Dear Mr. Mc Millan:

As you may recall, I was in attendance at the meeting the Association had in October with Assistant Secretary Scannell and other OSHA representatives. The purpose of this letter is to seek a clarification from OSHA as to whether orthodontic wires are considered "sharps" under the referenced Instruction and 29 CFR 1910.141.

This matter was brought to our attention when a Michigan dentist named Paul Ponitz was cited for failing to treat used orthodontic wires as sharps. Copies of the citations against him are enclosed. This was the first time anyone in the Association had ever heard of OSHA interpreting orthodontic wires to be a sharp which must be disposed of in appropriate sharps containers.

We are concerned because this directly contradicts the position taken by the Environmental Protection Agency (EPA), which has concluded that orthodontic wires are not sharps under the Federal Medical Waste Tracking Act and the accompanying EPA regulations. It creates major problems for our members and others when the two federal agencies regulating infectious waste interpret the waste disposal rules in an inconsistent manner.

Please provide us with a written response explaining OSHA's position on this issue. Because we are in the process of doing an update on our Federal Regulatory Compliance Manual, we would appreciate a response by April 5 if at all possible.

Sincerely,



Carole Frings
Federal Agency Representative



March 22, 1990

Mr. Alan Mc Millan
Deputy Assistant
Secretary of Labor for Occupational
Safety and Health
Department of Labor
200 Constitution Avenue, N.W.
Room S2315
Washington, D.C. 20210

Re: Request for Clarification of OSHA Regulations Applicable to Dentistry

Dear Mr. Mc Millan:

The purpose of this letter is to seek clarification of a number of OSHA regulations that may apply to dentistry. Many of these have only recently been brought to our attention and we are uncertain whether they are state-approved plan rules or federal rules, or whether they even apply to dental workers. In some cases, dentists have reported being cited by OSHA for these offenses. In other instances, dentists have simply raised the question with us in order to seek clarification of their responsibilities. Please provide us with written responses to the following questions:

1. Is there an OSHA rule requiring a dentist to have an eyewash station in the office? If so, please give the citation to the rule. Where must the eyewash cup be located? How many per office are required? Must the eyewash station be connected to plumbing so as to facilitate continuous flushing of the eye? We have received reports of citations against dental schools and individual dentists for violating this rule.
2. Under the February 27 revision to the compliance instruction, must all needlestick and other sharps injuries be reported on the Form 200 injury log if the office has 11 or more employees? We assume so because all sharps injuries require a Hepatitis B and HIV test, as well as other medical procedures, so we interpret this as requiring "medical treatment."
3. Cold sterilization trays are sometimes used to soak instruments. The trays may sit around for days. Are the trays required to be labeled under the Hazard Communication rule?
4. There are tanks in dental office darkrooms containing X-ray developer and fixer solutions. Typically there are four tanks per darkroom. Must these trays be labeled under the Hazard Communication rule?
5. First Aid. Recently the Oregon OSHA office advised dentists that there is a requirement to have a certain type of First Aid Kit available for treatment of injuries to workers, as well as a qualified First Aid person and an emergency medical plan. Is there a federal OSHA rule on this? If so, please give us the citation to that rule.
6. Is there a rule that stairways must have proper handrails? If so, what is the citation?
7. Are fire extinguishers required and must employees be trained in their use? What is the citation for this?
8. Under the Compliance Instruction, how does OSHA define "infectious waste?" No definition is provided in the language of the Instruction itself, and this leads to OSHA inspectors defining it differently than the EPA's definition of infectious waste.
9. Is there a federal OSHA rule on the following equipment? If so, please provide us with a copy of the regulations, if they are applicable in a dental office.

• Electrical cords and equipment properly grounded and in good repair.
• Any belt drives (such as on air compressor) or other hazardous moving machinery properly guarded.
• Main switch panels/circuit breakers legibly marked to indicate disconnecting means/purpose.
• Lockout/Tagout Program developed and implemented.
• Compressed gas cylinders secured against being tipped over.

In order to correctly inform our members, we would like to incorporate your responses into the next update of the Association's Regulatory Compliance Manual. Because the text of the changes is due to the printer by May 1, we would greatly appreciate a response from you by April 6, if at all possible. We sincerely appreciate any assistance you can give us in keeping our members fully informed of current requirements. Please feel free to call me if you have any questions.

Sincerely,



Carole Frings
Federal Agency Representative