CDA Regulatory Compliance Manual
FREQUENTLY ASKED QUESTIONS
March 2004
CAL/OSHA REGULATIONS
Cal/OSHA posts frequently asked questions about the bloodborne pathogens standard at
http://www.dir.ca.gov/dosh/BloodborneFAQ.html. This document provides useful interpretation of the
regulation.
What type of personal protective equipment (PPE) should employees wear?
Cal/OSHA requires that PPE be “appropriate,” which means PPE should not permit blood or other potential
infectious materials pass through employee’s underlying garments to reach the skin, eyes, mouth, etc. In a
general dental office, PPE should go from the neck down to thigh length and down to the wrists--no high
collars necessary; no V-necks permitted. Periodontal offices may require more elaborate PPE, orthodontic
offices may require less. Gloves, goggles, glasses with side shields or a face shield should be worn during
procedures, and when working with disinfectants and sterilants.
Uniforms are typically not PPE and are not the responsibility of the employer. However, if the employer
provides uniforms for the purpose of preventing contact with blood or other potentially infectious material, the
uniforms become PPE and are subject to Cal/OSHA requirements. During the course of a day, PPE should be
changed if necessary to avoid cross contamination.
Employers are required to provide PPE for employees who come in contact with patients during treatment and
who handle disinfectants/sterilants, at no cost to the employee.
Can employees take home their personal protective equipment (PPE) to launder? Does the dentist
have to pay for a commercial laundry service?
Employees may NOT take home PPE. The employer is responsible for cleaning, laundering, repairing,
replacing, or disposing PPE and other contaminated laundry. To launder, the employer may choose one of four
methods:
Use a commercial laundry service that picks up and delivers.
Install a washer and dryer at the office; train employees on appropriate handling of the laundry; list
handling of the laundry as part of employees’ job descriptions.
Use a commercial laundromat (not apartment laundromats); train employees on appropriate handling
of the laundry; list handling of the laundry as part of employees’ job descriptions.
Employer, if not incorporated, may take laundry to his or her home to clean.
FAQ-1 March 2004
An employee was stuck with a contaminated needle (or sharp instrument) . . . What do I do?
First, clean and treat the wound, and offer an immediate confidential medical evaluation and follow-up. This is
made available at no cost to the employee. The employee should be referred to a healthcare provider who will
perform all medical evaluations and procedures in accordance with current U.S. Public Health Service
recommendations. These medical evaluations and procedures include the collection of the employee’s blood
and testing for HBV, HCV and HIV status, counseling, post-exposure prophylaxis, and evaluation of reported
illnesses. The U.S. Public Health Service recommends that post-exposure prophylaxis for HIV start within 1 to
24 hours of an exposure incident and notes that use of chemopropylaxis is a clinical decision dependent on the
characteristics of the injury (see “Updated U.S. Public Health Service Guidelines for the Management of
Occupational Exposures to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis”
MMWR June 29, 2001; Vol. 50 (No. RR-11)). If the employee refuses the medical evaluation, document this
refusal and include it as part of the Exposure Incident Report to be placed with the employee’s medical
records.
Determine and document how the exposure occurred. A sample Exposure Incident Report and Sharps Injury
Log are included in the Records section of this manual. Both documents must be completed. A copy of the
Exposure Incident Report should be provided to the healthcare provider and another copy placed in the
employee’s confidential medical record.
If a patient was treated with the same needle or instrument prior to the exposure incident, identify the patient if
possible, and document it in the Exposure Incident Report, unless prohibited by state or local law. Contact the
source patient and request his or her consent to test for HBV, HCV and HIV carrier status, and to disclose the
information to the employee. If consent is not obtained, have the individual sign a nonconsent form and
include it as part of the Exposure Incident Report. Inform employee of test result when available.
Certain information must be provided to the healthcare provider who performs the medical evaluation or any
follow-up treatment. These are:
A copy of the Bloodborne Pathogens Standard (Appendix 1 of this manual)
Description of employee job duties during incident
Documentation on routes of entry/exposure circumstances (Exposure Incident Report)
Results of the source individual’s blood testing, if available
Medical record on employee HBV vaccine
The healthcare provider is to provide to the employer a written opinion that is to be given to the employee
within 15 days of completion of the evaluation. This written opinion must contain the following information:
Necessity of HBV vaccine, or if it was provided to the employee
That the employee was informed of evaluation results and medical conditions which require further
evaluation or treatment
All other findings remain confidential, and are not included in the written report.
See EXPOSURE CONTROL PLAN and RECORDS sections in the manual. Detailed procedures are outlined
on pages EC-24 to EC-26.
FAQ-2 March 2004
An employee was stuck with a sterile needle (or sharp instrument) . . . What do I do?
The procedures described in response to the previous question do not have to be followed because an
“exposure incident” did not occur. An exposure incident is defined by Cal/OSHA as a specific eye, mouth,
other mucous membrane, non-intact skin, or parenteral contact with blood or other potentially infectious
material that results from the performance of an employee’s duties.
Am I required to use safety needles?
Amendments made in 1999 to Cal/OSHA’s Bloodborne Pathogens standard require the use of “needleless
systems, needle devices with engineered sharps injury protections, and non-needle sharps with engineered
sharps injury protection,” subject to four (4) exceptions. These exceptions are 1) lack of market availability; 2)
information indicating that the device will jeopardize patient care or safety, 3) information indicating that the
device is not more effective in reducing sharps injuries than the device currently used by the employer; and 4)
lack of sufficient information to determine whether a new device on the market will effectively reduce the
changes of a sharps injury.
The requirements apply to dental instruments that are sharps, as well as to needles. If you claim an exception
to the requirement to use devices with engineered sharps injury protections, you must document it. At this time
dental offices may use exception #1 for many dental instruments. If applicable, you may use exceptions #2,
#3, or #4 with regards to safety needles. Include all documentation as part of the Exposure Control Plan.
NOTE: Cal/OSHA's Policy and Procedures Manual states the following with regard to the utilization of
Exception 4: "The effort required by the employer to keep abreast of new information will depend on the
employer's size and sophistication. For small healthcare and dental offices, it will generally be sufficient if they
rely on peer organizations, academic studies, and professional journals to track currently available information
on devices. Larger, more sophisticated employers will be required to make more direct efforts to evaluate
devices. The employer's approach to this issue must be reflected in the Exposure Control Plan." This
information can be accessed at www.dir.ca.gov/DOSHPol/P&PC14.htm.
To identify available safety needles and other sharps with engineered sharps injury protection, you can make
inquiries with your dental supplier, check trade publications and trade shows, or review dental journals for
information. The state Department of Health Services does maintain a database of safety needles at
http://www.dhs.ca.gov/ohb/SHARPS/Default.htm.
The Oral Health Division of the Centers for Disease Control has developed sample screening and device
evaluation forms. These are available at http://www.cdc.gov/OralHealth/infection_control/forms.htm.
What are the requirements for Hepatitis B vaccination? Are post-vaccination testing and booster
shots required? When does an employee get the vaccination? Where do I send them to get
vaccinated?
The vaccination must be made available to employees, who are occupationally exposed, within ten working
days of initial assignment. The employee must be provided with information on its efficacy, safety, method of
administration, benefits and that it is provided at no cost to the employee. Exceptions to the requirement to
offer the vaccination include: (1) the employee has already received the complete vaccination series; (2)
antibody testing has revealed that the employee is immune; or (3) the vaccination is contraindicated for medical
reasons. The employer may not require an employee to be screened for antibodies in order to receive the
vaccination.
FAQ-3 March 2004
Hepatitis B vaccinations are administered in three doses, with the second and third doses administered at 1
month and 6 months after the first. Vaccinations should be received intramuscularly (in the deltoid). A
December 1997 update in CDC recommendations now makes mandatory post-vaccination screenings for
employees provided with the Hepatitis B vaccine. Serological conversion should be tested within one to two
months of the last shot of the three-shot series. If the screening shows the vaccine did not work, the employer is
required to offer to pay for a second vaccine series. The U.S. Public Health Service does not recommend
routine serologic testing and booster shots.
If an employee agrees to the vaccination, the employer is responsible for paying for the vaccination, post-
vaccination screening, and, if indicated, a second vaccination series. Check with public health clinics,
outpatient clinics, hospital occupational health services departments, or a physician for information where
employees can receive the vaccination.
If an employee declines the vaccination, the employer must ensure the employee signs a declination form. The
declination’s wording must be identical to that found in the regulation (Appendix A of Section 5193,
Bloodborne Pathogens). See the Records section in the manual.
If an employee initially declines the vaccination then decides to have it, the employer must pay for the
vaccination, post-vaccination screening, and second vaccination series, if necessary.
What are the regulations related to tuberculosis?
Federal OSHA recently announced its intentions to withdraw a proposed tuberculosis standard. However,
enforcement policies and procedures in California, under Section 3203 – Injury and Illness Prevention Program
and Section 5144 – Respiratory Protective Equipment, have targeted high-risk facilities such as hospitals,
correctional institutions, homeless shelters, and drug treatment centers. Dental staff who work at these
facilities would be impacted by these policies.
Staff at the typical dental office is not required to be tested for TB, nor is a written plan to prevent TB exposure
required.
It is highly recommended for dental offices to follow the Centers for Disease Control, "Guidelines for
Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Facilities, 1994,” MMWR 43 (no.
RR-13) http://www.cdc.gov/mmwr/preview/mmwrhtml/00035909.htm. Recommendations include conducting
a periodic risk assessment and requesting patient's TB history.
Should we scrub the instruments before putting them in the sterilizer?
Instruments must be cleaned thoroughly before sterilization or high-level disinfection. Cleaning can be done
with the use of an ultrasonic cleaner. If, after using the cleaner, material continues to stick to the instrument,
use a long-handled brush with soap and water, or a detergent, to scrub off the material. Heavy-duty utility
gloves should be worn when cleaning instruments. Cal/OSHA forbids sharps from being stored or processed
in a manner that requires employees to reach by hand into the containers where these sharps have been placed.
FAQ-4 March 2004
What needs to be in a medical emergency kit?
Most dental offices have one emergency kit to be used for both employees and patients. For employees,
Cal/OSHA does not specify what should be in a medical emergency kit, just that the employer have
documentation that a physician approved the kit. For patients, it is recommended the kit contain: oxygen,
blood pressure monitoring equipment, epinephrine, Benadryl, a quick source of glucose, nitroglycerin, and a
CPR pocket mask. The drugs should be checked periodically to ensure they have not expired.
For offices where general anesthesia is used, the Board of Dental Examiners requires specific equipment
(Section 1043.3 of the Dental Practice Act).
Do I have to have a permit for my air compressor?
Cal/OSHA requires a permit for compressors 1 ½ cubic feet in volume or larger, or when the safety valve is set
greater than 150 psi. All compressor tanks should have a nameplate with the ASME code symbol (a clover
leaf with a “U” or “UM” in it) to indicate compliance with the ASME Code. Contact Cal/OSHA's Pressure
Vessel Section to arrange inspection of your tank so it may be permitted. You will be charged for both the
inspection ($135), permit ($15), and travel time. A typical permit is issued for five years, and then the
compressor must be inspected again for a new permit.
You can call the Pressure Vessel Section in Oakland, (510) 622-3066 or Anaheim, (714) 939-0434.
Are personal monitors required to monitor employee exposure to formaldehyde or nitrous oxide?
If an employer can document, using objective data, that the presence of formaldehyde or formaldehyde-
releasing products in the workplace cannot result in concentrations of airborne formaldehyde that would cause
any employee to be exposed at or above the action level (AL) of 0.5 ppm, calculated as an eight-hour time-
weighted average concentration, or 2 ppm, as a 15-minute short term exposure limit, under foreseeable
conditions of use, the employer is not required to provide personal formaldehyde monitors. Such objective
data may be available from the manufacturer of your sterilizing unit. You could also do initial monitoring. If
initial monitoring indicates an exposure level higher than either of the above limits, you must take steps to
reduce it. Follow-up monitoring should be conducted every six months, and may be discontinued if two
consecutive measurements, taken at least one week apart, record levels below the limits.
For nitrous oxide, an employer needs to monitor the work environment if he or she believes individual staff
may be exposed to concentrations in excess of 50 ppm, which is a time-weighted average permissible exposure
limit (PEL) for an eight-hour day. Effective scavenging equipment and periodic inspection of equipment
should keep nitrous oxide exposures to within acceptable limits. For additional information on keeping nitrous
oxide pollution to a minimum, contact and request a copy of "Common Questions Regarding the Use of
Nitrous Oxide."
The National Institute for Occupational Safety and Health (NIOSH) recommends an average level of 25 ppm
not be exceeded during an 8-hour day. However, Cal/OSHA has not adopted this more-stringent limit. Federal
OSHA has not established occupational exposure limits for nitrous oxide.
FAQ-5 March 2004
What are the requirements for eyewash stations?
Cal-OSHA requires emergency eyewash facilities be accessible in locations that require no more than 10
seconds for the injured person to reach. Plumbed or self-contained eyewash equipment must meet the
requirements of sections 5, 7, or 9 of ANSI Z358.1-1981, Emergency Eyewash and Shower Equipment. Water
hoses, sink faucets, or showers are not acceptable eyewash facilities. Eyewash stations must be plumbed for
each eye, to provide cold water.
What do I have to do to comply with the ergonomics regulation?
Effective July 3, 1997, California’s ergonomics regulation requires an employer to implement a repetitive
motion injury prevention program when at least two employees, performing the same job or work activity,
develop repetitive motion injuries. The program should include a worksite evaluation, control of exposures
that caused the injuries, and training employees. The regulation presently exempts employers with fewer than
ten employees; however, current legal and legislative proceedings may change this. To learn more about what
you can do to reduce repetitive motion injuries in the office, contact your worker’s compensation company.
What are Cal/OSHA’s training requirements?
Employee training must be done at time of hiring, whenever new hazardous materials or potentially hazardous
procedures are introduced and at least once a year after initial training. Annual training should include the
injury and illness prevention plan, exposure control plan (bloodborne pathogens), hazard communication plan,
and fire and emergency plans. Training should be specific to the hazards of the job and to the particular work
site. For example, front-office staff who do not work in the operatories, laboratories, or sterilization rooms
probably do not need exposure control training. The training instructor could be a lecturer, consultant, or office
staff who is knowledgeable of regulatory requirements and standard practices of the dental office. You should
document the training each employee has.
Do I need to post an OSHA Log 200? What is an OSHA Log 300? What workplace injuries and
illness must I report?
As of 2002, most dental offices are exempt from maintaining an OSHA Log 300. The OSHA Log 300 replaces
the OSHA Log 200, which provides a summary of work-related injuries and illnesses during a calendar year.
Businesses with more than 10 employees are required to complete the log and post it during the month of
February. Dental offices that were required to maintain the OSHA Log 200 in 2001 should have posted the log
during the entire month of February 2002. Each log must be retained for five years after the year the injuries
were recorded.
The new Cal/OSHA rules went into effect on January 1, 2002. The new regulations require a dental office to
record work-related injuries and illnesses when the business is requested to do so in writing by OSHA, Bureau
of Labor Statistics, or Cal/OSHA. Any business that receives an injury and illness survey from these agencies
also is required to complete the survey and return it as directed.
The new regulation does not exempt dental offices from recording injuries on a sharps injury log or from
documenting incidents of exposures to bloodborne pathogens.
Work-related incidents that lead to serious injury or illness, or death, must be reported immediately to the state
FAQ-6 March 2004
Division of Occupational Safety and Health. Serious injury or illness is defined as any injury or illness which
requires inpatient hospitalization for a period in excess of 24 hours for other than medical observation or in
which an employee suffers a loss of any member of the body or suffers any serious degree of permanent
disfigurement.
How long must I store training records, inspection logs, and other paperwork?
Injury and Illness Prevention Program safety inspection logs and employee training records must be kept for
one year, except for employees who have worked for less than one year and to whom records were given upon
termination.
Bloodborne Pathogens/Exposure Control Plan employee training records must be kept for three years from date
of training. The Sharps Injury Log must be kept for five years from the date of the exposure incident.
Employee medical records, kept in accordance with the Bloodborne Pathogens and Access to Employee
Exposure and Medical Records standards, must be kept for the duration of employment plus 30 years.
MSDS's must be kept for 30 years.
Do you have OSHA consultants who can make on-site visits?
CDA does not have staff to provide on-site Cal/OSHA consultations; however, an OSHA Resources Directory
has been compiled for use by members. Companies and individuals listed in the directory are self-referred, and
their products and services are not guaranteed by CDA.
Cal/OSHA does have a consultation service, (800) 963-9424, and a listing of regional offices can be found
here: http://www.dir.ca.gov/dosh/consultation_offices.html. Consultation staff is available by telephone and,
also, to visit your office and advise you on changes that should be made. You are given a period of time to
make the changes. If they are not done, the consultants are obligated to report it to the enforcement branch,
which can then cite and fine you for noncompliance.
What other Cal/OSHA regulations do I need to comply with? Where can I find more
information?
Far more than space allows to detail here. Cal/OSHA’s number one priority is employee safety. If you, as the
employer, also have employee safety as one of your staff training and management priorities, compliance with
Cal-OSHA regulations can be less worrisome.
Some miscellaneous regulations with which to comply include:
appropriately placed and illuminated exit signs
warning signs for automated equipment
recordkeeping and posting requirements
machine guards
consumption of food and beverage prohibited in certain work areas
Cal/OSHA regulations are available on the Internet. You can start at the Table of Contents and Search page at
http://www.dir.ca.gov/Samples/search/query.htm. Cal/OSHA’s Policies and Procedures Manual also is
available on the Internet at http://www.dir.ca.gov/samples/search/querypnp.htm.
FAQ-7 March 2004
I received a letter from the Division of Occupational Safety and Health regarding a complaint--
what do I have to do?
Non-formal, non-serious complaints are investigated by letter to the employer in lieu of an on-site inspection.
However, district managers have been given some discretion to do on-site investigations of these complaints.
If you get a letter and you respond to their request for information, do not expect Cal/OSHA to send you any
notice of having satisfactorily answered its inquiries. If Cal/OSHA finds an employer’s response
unsatisfactory, an unannounced, on-site inspection will be made.
Some non-formal, serious complaints also may be investigated by telephone or fax. Employers will be
contacted first by telephone, then by faxed letter. The employer has five working days to respond; employers
who do not respond will be scheduled for an on-site inspection. Follow-up inspections may be done for some
of the complaints that are handled through this process.
What happens during an on-site inspection?
Cal/OSHA inspections typically are triggered by employee complaint. The agency prioritizes a complaint by
type of hazard and employer’s citation history. Complaints also are categorized as non-formal or formal
dependent on whether the complainant identifies himself or herself to the agency. Complaints also determined
to be serious or non-serious based on the probability of injury. Based on this information, the agency decides
whether to make an on-site inspection or investigate by letter or fax.
Programmed inspections occur when the agency is targeting an industry, for example, agriculture and the
garment industry have been recent targets of programmed inspections. Also, there is a possibility of an
inspection if a neighboring dental office has had frequent complaints and inspections.
What can you expect from an on-site inspection?
You will not get advanced notice. If you are busy with a patient when the inspector arrives, you can request
the inspector wait until you have some free time or return at a more convenient time. However, be aware that
an inspector can refuse this request and demand to be seen immediately. If you refuse his or her demand, the
inspector can leave the premises, obtain a search warrant, and return to your office to do a very thorough
inspection.
Inspector will first meet with the employer or designated representative. This is called an opening conference.
Be sure to check his or her credentials. The inspector should explain the purpose and scope of the inspection,
but he or she is not obligated to reveal the identity of the complainant or the nature of the complaint. Inspector
will request to see, or have a copy of, various documents such as your Injury and Illness Prevention Plan,
Exposure Control Plan, Hazard Communication Plan, required posters, proof of worker’s comp insurance, etc.
Inspector will do a walk-around inspection. The inspector may stop employees in the course of their duties to
ask questions, such as, "Do you know where the material data safety sheets are?" The inspector may take
photographs. Inspector may meet with employees in private, usually without the employer present.
Inspector will meet with the employer or designated representative prior to leaving the premises. This is an
exit conference. The inspector will note whether any violations were observed, however citations may be
issued at the exit conference or at a closing conference to be held within a few weeks of the inspection. The
inspector may return for follow-up inspections.
FAQ-8 March 2004
At the closing conference, the inspector will review the citations, penalties, requirements for posting
documents, and methods to achieve compliance. The inspector also will inform you that you may choose to
have an informal conference with a district manager to discuss the inspection and enforcement action. He or
she will also discuss the appeals process.
A follow-up inspection may be conducted.
DENTAL OFFICE WASTE
What types of dental office wastes are subject to regulation?
Dental office wastes can be separated into three categories: (1) Hazardous wastes (2) Medical wastes and (3)
Universal wastes. The table on the next page lists the hazardous, medical, and universal wastes typically
generated by dental offices, and lists options for managing the wastes. Refer to Appendix 5: Waste
Management Guide for Dental Offices for more detailed information.
DTSC publishes a fact sheet for “Small Quantity Generators: Dental, Medical and Veterinary,” available on
the internet at http://www.dtsc.ca.gov/PublicationsForms/OAD_DocVet_FS_01-03.pdf or from a DTSC Duty
Officer at (800) 728-6942.
Why do I need to an EPA identification number?
Any business in California that generates hazardous waste must have an EPA identification number. This
number should be noted on manifest forms used when having your waste picked up. Most dental offices only
need a Cal-EPA number; practices that generate more than 27 gallons of hazardous waste per month at one
office will also need a U.S. EPA identification number. Call Cal-EPA Department of Toxic Substances
Control for more information and forms, 1-800-618-6942 or (916) 324-1781.
FAQ-9 March 2004
WASTE MANAGEMENT OPTIONS ACCUMULATION/
STORAGE TIMES
HAZARDOUS/ For small quantity generators
UNIVERSAL (less than 270 lbs per month)
Amalgam, including 1. Send to recycler One year from accumulation start
teeth with amalgam 2. Manage as a hazardous waste date.
Do not place in trash or with medical waste.
Traps and filters that 1. Send to recycler One year from accumulation start
contain amalgam 2. Manage as a hazardous waste date.
Do not place in trash or with medical waste.
Fixer 1. Haul offsite to a licensed reclaimer One year from accumulation start
2. Treat before discharge to the sewer (check with local date.
sanitation agency)
Developer 1. Contact local sanitation agency regarding sewer discharge One year from accumulation start
requirements date.
2. Manage as hazardous waste
Lead foil from film 1. Send to metal reclaimer, or One year from accumulation start
packets 2. Manage as hazardous waste date.
Glutaraldehyde solutions 1. Treat before discharge to the sewer (check with local One year from accumulation start
sanitation agency) date.
2. Manage as hazardous waste
Vapo-Steril 1. Manage as hazardous waste One year from accumulation start
date.
X-ray system cleaners 1. Manage as hazardous waste One year from accumulation start
that contain chromium 2. Switch to non-chromium-based cleaner date.
MEDICAL
Sharps 1. Picked up by medical waste hauler for treatment/disposal No more than 7 days after container
2. Mail off-site for treatment is filled
3. Treat by DHS-approved permit-exempt method, followed
by disposal in regular trash
Biohazardous -- Solid 1. Picked up by medical waste hauler for treatment/disposal If less than 20 lbs generated per
'Red-Bag' Waste month:
30 days if stored above 0°C
90 days if stored below 0°C
Biohazardous -- 1. Picked up by medical waste hauler for incineration. Up to 1 year if less than 10 lbs of this
Pharmaceutical waste is generated per year
How do I dispose of spent photographic fixer and developer?
You are prohibited from pouring photographic fixer down the drain. You must have the fixer hauled off-site
for recycling, or treat it using a silver recovery unit. Using a silver recovery unit does not require a permit. If
you use a silver recovery unit, check with your local sanitation agency prior to disposing the treated solution to
the sewer. Most local sanitation agencies prohibit discharges that have more than 5 ppm silver.
Electrowinning and metallic replacement are two methods used in silver recovery units to treat fixer. The
spent fixer is run through a device that removes most of the silver so the solution could be disposed down the
drain. However, the remaining sludge must be properly disposed or recycled. Check with a dental products
distributor for information on silver recovery units. Products which "solidify" the fixer for disposal in a landfill
may not be used without a treatment permit.
Spent developer is not hazardous waste if the pH is not greater than 12.5. However, before disposing it to the
sewer, check with the local sanitation agency on regulations prohibiting disposal in the sewer system.
FAQ-10 March 2004
How do I dispose of sterilizing solutions such as glutaraldehyde or Harvey
Vapo-Sterile solution?
Recent legislation allows facilities to treat (neutralize) waste glutaraldehyde solutions without a permit under
the following conditions:
the glutaraldehyde was used for instrument disinfection
the treatment takes place at the facility where the waste was generated
the sole active chemical of the neutralizing solution is glycine.
Before purchasing the neutralizing solution, check with your local sanitation agency regarding any prohibitions
for discharging the treated solution to the sewer.
The DTSC Fact Sheet for Small Quantity Generators (January 2003) states, “If you prefer to dispose of your
wastes rather than treat them onsite, you will still need to characterize them as hazardous or non-hazardous,
and handle them appropriately. Glutaraldehyde degrades after activation and most likely will become non-
hazardous within the allowed hazardous waste accumulation time (90-180 days). . . . However, the DTSC has
not studied the degradation timeline nor the toxicity threshold, and therefore cannot make a recommendation
for retention time or toxicity threshold concentration. As long as the degradation occurs unaided by the
generator (addition of heat, chemicals other than glycine, aeration, etc.), and it occurs within the allowed
accumulation time, authorization from the DTSC is not required. Generators of waste glutaraldehyde who
wish to claim that it has degraded to non-hazardous levels should check with their suppliers to see if they have
data to support determinations that the waste will degrade to non-hazardous levels over a set period of time. If
the data is not available, generators will have to produce their own supporting data to make the determination,
or handle the wastes as hazardous wastes.”
Spent Harvey Vapo-Sterile solution is hazardous waste because of its ignitability. A licensed and registered
hazardous waste hauler must pick it up.
For other sterilizing solutions, check the MSDS for manufacturer’s recommendation on disposal. Be aware
that local sanitation agencies may prohibit discharges of some solutions into the sewer system.
How do I dispose of scrap amalgam? Lead foil from x-ray packets?
Recycling is the preferred method for disposing scrap amalgam and lead. If they are not recycled, they must be
managed as hazardous waste.
Effective March 15, 2003, the California Department of Toxic Substances Control (DTSC) implemented new
regulations which classify several categories of discarded mercury-containing products - including dental
amalgam - as universal waste. Universal waste regulations encourage recycling and allow certain hazardous
wastes to be managed under standards that are typically less stringent than full hazardous waste regulations.
Under DTSCs new regulations, dental amalgam wastes gathered from single-use amalgam traps, as well as
amalgam fines and sludges removed from reusable traps, lateral lines, etc., may be classified as universal
wastes if they are managed as recyclable material.
The regulations outline the following required best management practices:
Handlers are required to accumulate recyclable dental amalgam waste in properly labeled, airtight
containers. Keep in mind that if the amalgam waste is not recycled, then it must be disposed as
hazardous waste.
Handlers are prohibited from rinsing amalgam traps into a sink.
FAQ-11 March 2004
Handlers are prohibited from placing amalgam waste into a medical waste container.
These best management practices have been recommended in the past to facilitate compliance with other
existing environmental health and safety regulations.
Who enforces the laws regarding hazardous wastes, and what fees do I have to pay?
Local agencies enforce certain elements of the hazardous waste laws. Dental offices are likely to be contacted
by these “Certified Unified Program Agencies,” (CUPAs) with regard to regulations governing hazardous
waste generators. See the Waste Management Guide in this manual for a list of CUPAs. Individual CUPAs
determine if dental offices will be regulated for generation of photographic fixer, or for other elements of the
Unified Program. Individual CUPAs set the fee dental offices are charged, and also collect the state surcharge.
The annual state surcharge is currently $24.00.
For additional information on the Unified Program, see Cal/EPA’s web site,
http://www.calepa.ca.gov/cupa/Default.htm.
What is regulated medical waste?
Regulated medical waste is comprised of sharps waste and biohazardous waste.
Sharps waste in a dental office includes needles, syringes, blades, endo files, burs which have been
contaminated with body fluids, broken carpules contaminated with blood.
Biohazardous waste in a dental office includes:
disposable items that drip blood when compressed, or flake dried blood when shaken, e.g., dressings,
gauze, cotton rolls
human surgery tissues
expired drugs, pharmaceutical wastes
Teeth are not biohazardous waste, unless deemed infectious by the dentist. Disposable items, such as bibs and
gauze, which are slightly soiled by blood or saliva are not biohazardous waste.
Note: To dispose of teeth containing amalgam fillings, if not to be returned to the patient, then they must be
recycled or disposed as hazardous waste, due to the heavy metal content. Ideally, they should be recycled as
heavy metals; if not recycled, then they must be disposed as hazardous waste.
How long may medical waste be stored before disposal?
Except for pharmaceutical waste, biohazardous waste generated by small-quantity generators (less than 20
pounds per month) may be stored on-site at more than 0 degree Centigrade for 30 days. On-site storage for 90
days is allowed if the waste is kept at less than 0 degree Centigrade. Sharps waste must be collected within
seven days after the container becomes full. Pharmaceutical waste may be stored on-site for up to one year if
less than ten pounds of pharmaceutical waste is generated annually.
FAQ-12 March 2004
Who enforces the laws regarding medical waste, and what fees do I have to pay?
The state Department of Health Services and local enforcement agencies enforce the Medical Waste
Management Act (MWMA). A list of local enforcement agencies can be found in the Directory of Regulatory
Agencies in this manual. In those counties where DHS is the enforcement agency, the annual small quantity
waste generator fee is $25. Your medical waste hauler may collect this fee on behalf of the agency, and this
would be stated on your invoice. The generator fee can be higher in those counties and cities that have a local
enforcement agency, and the fee is these jurisdictions are determined by the local city council or board of
supervisors.
The MWMA became effective January 1, 1991. A summary of the medical waste program and a link to the
MWMA can be found at http://www.dhs.ca.gov/ps/ddwem/environmental/emb/medwasteindex.htm. This site
includes lists of local enforcement agencies, medical waste transporters, and approved alternative medical
waste treatment technologies.
PROPOSITION 65
Must I comply with the requirements of Prop. 65?
Dentists with 10 or more employees must post a notice sign in their offices that alert individuals, including
their patients, to the possibility of exposure to various chemicals used by that office.
Compliance with Cal/OSHA’s Hazard Communication Plan is deemed a satisfactory warning to employees,
but patients and others must be warned in other ways. All dentists employing more than nine employees must
post the required notice sign included in the poster set . CDA strongly encourages offices with less than ten
employees to post the notice sign, because the definition of employee is broad, and dentists should err on the
safe side by posting the sign.
The notice sign must be prominently placed in a location which will afford the patient a reasonable opportunity
to receive notice of the exposure and which provides a “clear and reasonable warning” to all patients and
visitors prior to exposure. There is sufficient leeway in the standard to allow dental offices to determine
whether the signs should be posted at the entrance, in the waiting room, in the operatory, or in more than one
of these locations. However, a single sign prominently displayed in the waiting room is deemed to be in
compliance.
NOTICE TO PATIENTS
Proposition 65 WARNING: Dental Amalgam, used in many dental fillings, causes
exposure to mercury, a chemical known to the State of California to cause birth defects or
other reproductive harm.
Root canal treatment and restorations, including fillings, crowns, and bridges, use
chemicals known to the State of California to cause cancer.
The US Food and Drug Administration has studied the situation and approved all dental
restorative materials for use.
Consult your dentist to determine which materials are appropriate for your treatment.
FAQ-13 March 2004
A full-size copy of the notice is also available for downloading on CDA Online,
http://www.cda.org/member/news/prop65_poster.pdf. Additionally, CDA has developed Proposition 65 FAQ
documents for both dentists and patients to provide information on the issue; the FAQs are also available at
CDA Online.
RADIATION SAFETY
Why do I have to pay a fee to register my x-ray machine? Why isn’t the other dentist in my
building receiving the same bill from the Department of Health Services?
State and federal laws requires the registration of all sources of radiation. The state collects a fee of
approximately $54 per tube per year for dental units. The fees are collected every other year, with the funds
designated for an inspection program. Dental x-ray units are to be inspected every five years.
Are personal radiation monitors required?
Records of exposure to radiation must be kept. Regulations allow an exception to monitoring if it can be
demonstrated that no employee is exposed to more than 10% of the maximum allowable annual dose, 5 rems.
If a dental office meets this exception, it is recommended that monitoring occur periodically to ensure that
exposure does not exceed this amount. That is, employees can wear the dosimetry badges for one year so that a
baseline level of exposure is established, and then monitoring every 3-5 year thereafter, as long as no
significant exposure is demonstrated.
Declared pregnant employees who operate x-ray machinery must wear personal x-ray monitoring devices for
the entire duration of pregnancy, or for as long as the employer knew about the pregnancy.
How are dental offices selected for x-ray machine inspection? What happens during an
inspection?
All dental offices must be sampled at five-year intervals, which means every year 20 percent of dental offices
with registered x-ray units are sent a thermoluminescence device (TLD) for exposure. The results of this
exposure are compared to established standards. The TLDs with the greatest deviation along with those
facilities that did not return the TLD are then scheduled for an inspection. Some offices that return TLDs in
the normal range may also be scheduled for an inspection because DHS must inspect at least half the number
of offices that were sent TLDs.
An inspection of a dental office is designed to evaluate compliance with radiation protection laws and
regulations. The inspection includes measurements (kVp, timer, exposure and filtration), processing
evaluation, and radiation protection procedures (posting of required documentation, patient/worker protection
procedures). From the inspection, recommendations are made to correct identified deficiencies. A typical
recommendation includes ways to lower patient/worker exposure. A notice of violation is issued if regulatory
violations are noted.
FAQ-14 March 2004