Today (4/28) Associated Press posted an article, Georgia Coronavirus Deaths Reach 1,000 Amid Openings. The article reports on coronavirus in Georgia and the impact Gov. Kemp’s order may have on the state, noting the order allows for resumption of elective procedures such as dental cleanings among others.

GDA member Dr. Peter Shatz, chair of GDA’s Innovation Task Force, did an excellent job instilling consumer confidence in visiting the dentist by relaying a key message that dentals offices have always followed the highest standards of disinfection and sterile techniques. The quote below appears in the article: 

Dr. Peter Shatz, chairman of the Georgia Dental Association’s innovation task force, said the practices where he works are screening patients by phone before they enter the office and checking their temperatures before putting them in the dentist’s chair.

Dentists and hygienists already wore gloves, masks and sometimes face shields. Shatz said now they will wear disposable gowns, plus surgical caps and shoe coverings.

“A restaurant is a little bit different than a dental practice where we can control the flow of patients,” Shatz said. “We have certain advantages over other businesses because we are good at keeping things clean.”

Associated Press operates 263 news bureaus in 106 countries. In the US their content is published by more than 1,300 newspapers and broadcasters reaching millions of readers. AP also operates the AP Radio Network, which provides newscasts twice hourly for broadcast and satellite radio and television stations

*The new OSHA Emergency Temporary Standard is not specifically aimed at dental offices. It instead broadly issues guidance for health care providers, which includes the dental profession*

Background

• On January 21, 2021, President Biden issued an Executive Order declaring that the health and safety of workers is a national priority and a moral imperative. The Order directs the Occupational Safety and Health Administration (OSHA) to take action to reduce the risk of employee exposure to contract COVID-19 in the workplace. In response, OSHA issued an Emergency Temporary Standard (ETS) to address this concern.

What is the Emergency Temporary Standard?

• The ETS seeks to protect workers facing the highest COVID-19 hazards, such as those in healthcare settings where suspected or confirmed COVID-19 patients are treated: hospitals, nursing homes, and assisted living facilities; emergency responders; home healthcare workers; and employees in ambulatory care. The ETS exempts fully vaccinated workers from masking, distancing, and barrier requirements when in well-defined areas where there is no reasonable expectation that any person with suspected or confirmed COVID-19 will be present.

What does this mean for dental offices?

• It is recommended that dental offices have a written COVID-19 plan in place. If an office is covered under the ETS, the ETS requires a written COVID-19 plan in place. If an office is exempt, it should still do a hazard assessment and written plan is recommended in OSHA’s Recommended Practices for Safety and Health Programs (beginning on pg. 19).
  
  
• Dental practices must also conduct workplace-specific hazard assessments for COVID-19 and should also continue pre-appointment patient screenings to identify individuals with suspected or confirmed COVID-19, rescheduling their appointments if possible or referring them as necessary.
  
  
• The ADA is making this recommendation as the CDC has not updated their Guidelines for Dental Settings since December 2020.

How to determine if your dental office is impacted by the ETS:

• According to the ADA, dentistry is largely exempt from the additional OSHA federal regulations. Dental offices most likely to be affected by the new standard include hospital-based oral surgery practices or those dentists who provide care for COVID-19 patients. However, all dental practices should refer to the chart below to determine if they are exempt from the new regulation:

What actions does my dental practice need to take if it is non-exempt based on the OSHA ETS flowchart?

• The standard will require non-exempt facilities to conduct a hazard assessment and have a written plan to mitigate virus spread, and requires healthcare employers to provide some employees with N95 respirators or other personal protective equipment. In addition, covered employers must ensure 6 feet of distance between workers. In situations where this is not possible, employers should erect barriers between employees where feasible.
  • Please see #7 in the ETS FAQ for specific hazard assessment guidance: https://www.osha.gov/coronavirus/ets/faqs
• The standard also requires covered employees to provide workers with paid time off to get vaccinated and to recover from any side effects. Covered employees who have coronavirus or who may be contagious must work remotely or otherwise be separated from other workers if possible, or be given paid time off up to $1400 per week. For most businesses with fewer than 500 employees, tax credits in the American Rescue Plan may be reimbursed through these provisions.

What if my employees are fully vaccinated, meaning it has been at least 2 weeks after their second dose in a 2-dose series, such as the Pfizer or Moderna vaccines, or 2 weeks after a single-dose vaccine, such as Johnson & Johnson's Janssen vaccine?

• The ETS exempts fully vaccinated workers from masking, distancing and barrier requirements when in well-defined areas where there is no reasonable expectation that any person will be present with suspected or confirmed coronavirus.

How soon do I need to implement this rule, if applicable to my practice?

• The ETS is effective immediately upon publication in the Federal Register. Employers must comply with most provisions within 14 days and with the remaining provisions within 30 days. OSHA will use its enforcement discretion to avoid citing employers who miss a compliance deadline, but are making a good faith effort to comply with the ETS. OSHA will continue to monitor trends in coronavirus transmission.

How should my dental practice proceed if we are exempt from the new OSHA rule based on the OSHA flowchart?

• If an office is exempt, it still should do a hazard assessment and written plan as recommended in OSHA’s Recommended Practices for Safety and Health Programs. Dental practices must also conduct workplace-specific hazard assessments for COVID-19 and should also continue pre-appointment patient screenings to identify individuals with suspected or confirmed COVID-19, rescheduling their appointments if possible or referring them as necessary.
  
  
• The ADA is making this recommendation to continue pre-appointment patient screenings as the CDC has not updated their Guidelines for Dental Settings since December 2020.

What are some options for screening individuals who enter the facility?

• From the OSHA ETS FAQ, screening may take different forms depending on the design and size of the facility. However, OSHA notes that it views asking questions about COVID-19 symptoms and illness as the minimum requirement for screening.
• Screening may also include confirming that individuals are abiding by any policies and procedures for wearing face coverings, as well as assessing individuals’ recent exposures to COVID-19. To comply with the screening requirement, an employer could assign an employee to each entrance to perform a health screening on each individual entering the facility.
• Employers could also contact patients, clients, residents, or other visitors by phone or video, prior to their arrival at the facility, to conduct the screening.

If my office is exempt from the new OSHA rule, can we take down the limited liability poster?

• The GDA recommends your dental practice should continue to post the limited legal immunity from COVID-19 related transmission claims poster until further notice, even if your practice is exempt from the new OSHA rule. The Georgia Assembly has extended the window of immunity until July 2022.

My office has less than 50 employees. Are we exempt from this rule and the written COVID-19 plan as a small business?

• Under the new OSHA ETS, if the employer has more than 10 employees, the COVID-19 plan must be written. OSHA's website contains significant compliance assistance materials, including a model plan.

Biden Executive Order Issued 1.21.21: https://www.whitehouse.gov/briefing-room/presidential-actions/2021/01/21/executive-order-protecting-worker-health-and-safety/

ADA Press Release Regarding the new OSHA Emergency Temporary Standard: https://www.ada.org/en/publications/ada-news/2021-archive/june/dental-practices-largely-exempt-from-osha-rule

Is Your Workplace Covered by the OSHA ETS Flowchart: https://www.osha.gov/sites/default/files/publications/OSHA4125.pdf

OSHA Emergency Temporary Standard (ETS) Fact Sheet: https://www.osha.gov/sites/default/files/publications/OSHA4122.pdf

OSHA Guidelines for Safety and Health Programs: https://www.osha.gov/sites/default/files/OSHA3885.pdf

OSHA ETS Subpart U: https://www.osha.gov/sites/default/files/covid-19-healthcare-ets-reg-text.pdf