OSHA Inspection: DR. EDWARD ABEYTA

Issued

Apr 7, 1989

Abate by

Jul 7, 1989

Penalty

Initial $120 · Current $120

Hazardous substances 1953

General-duty citation text

Section 5(a)(1) of the Occupational Safety and Health Act of 1970: The
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employer did not furnish employment and a place of employment which were
free from recognized hazards that were causing or likely to cause death
or serious physical harm to employees in that employees were exposed to
the hazards of nitrous oxide (N20) present as a waste anesthetic gas
while performing and assisting with dental operatory procedures.
a) The employer did not provide adequate controls during the period of
administration of N20 in order to control occupational exposure of
waste nitrous oxide gas. The employees were exposed to levels above
the recommended limit subjecting them to serious helath hazards of;
a) An increased rate of spontaneous abortion to females exposed to the
N20 gas;
b) An increased incidence of liver and kidney diseases, and;
c) An increased rate of congenital abnormalities to children born to
parents either or both of whom were exposed to N20, and;
d) Increased rate of development of neurological diseases.
b) The dental surgeon was exposed to 44 ppm of nitrous oxide at a
time-weighted average for a period of 480 minutes while performing
various dental surgeries on 11/21/88. This exposure is 1.76 times the
recommended limit of 25 ppm based on an eight hour (TWA) time
weighted average.
National Institute for Occupational Safety and Health (NIOSH)
occupational exposure to nitrous oxide, when used as the sole anesthetic
agent shall be controlled so that no worker is exposed to TWA
concentrations greater than 25 ppm during anesthetic administration.
Some feasible and acceptable abatement methods, among others, to correct
this hazard are:
1) Fresh air dilution by either air conditioning or employing a fresh
air recirculating system to reduce the concentrations of nitrous
oxide in areas away from patient and health care workers.
2) Use of a scavenging mask which incorporates an inner and outer mask
with a slight vacuum between the masks. The vacuum scavenges gases
exhaled as well as any excess gases from the anesthesia machine.
3) Air sweep: The air sweep consists of a fan which takes in air away
from the N20 Source. Fresh air is exhausted across the patients face
removing localized high concentrations of N20 in the patients
breathing zone.
4) Control leakage from the anesthesia machine by tightening and
repairing the following;
a) The high pressure system which includes components located between
high pressure N20 and the flow meters;
b) Wall connectors;
c) Loose high pressure hose connections;
d) Deformed compression fittings;
e) The low pressure system includes all parts located between the flow
meters and the patient.
5) Venting the anesthetic waste gases; suction pump variations of
anesthetic waste vacuum can be minimized by carefully planning the
site of entry of scavenging line into the vacuum system. The best
site is usually close to the pump.
6) Air monitoring program develop and implement an air monitoring
program to determine N20 leakage and employee exposure levels.
ABATEMENT NORMALLY WILL BE MULTI-STEP AS FOLLOWS:
STEP 1: Submit to the Area Director a written detailed plan of abatement
outlining a schedule for the implementation of engineering and/
or administrative measures to control employee exposure to
hazardous substances referenced in this citation. The plan shall
include, at a minimum, target dates for the following actions
which should be consistent with the dates required by this
citation:
a) Evaluation of the engineering/administrative control options;
b) Selection of optimum control measures;
c) Procurement, installation and operation of selected control measures.
d) Testing and acceptance or modification/redesign of controls.
All proposed control measures shall be evaluated for each particular
use by a competent Industrial Hygienist or other technically
qualified person. Ninety (90) day progress reports are required
during the abatement period.
STEP 2: Abatement shall have been completed by the implementation of
feasible engineering and/or administrative controls and upon
verification of their effectiveness of achieving compliance.

Issued

Apr 7, 1989

Abate by

May 7, 1989

Penalty

Initial $140 · Current $140

General-duty citation text

Section 5(a)(1) of the Occupational Safety and Health Act of 1970: The
employer did not furnish employment and a place of employment which were
free from recognized hazards that were causing or likely to cause death
or serious physical harm to employees in that employees were exposed to
infectious bloodborne diseases:
a) Employees such as, but not limited to, the dental assistants
performing and assisting with dental surgeries and routine procedures
while working throughout the dental practice are exposed to the
hazard of being infected with HBV and/or HIV through possible direct
contact with blood or body fluids:
Center for Disease Control (CDC) recommended universal precautions are
not being followed for all situations where blood and body fluids are/or
may be encountered.
1) The Hepatitis B vaccine was not offered to employees who are at
substantial risk of contacting blood and/or body fluids.
2) Appropriate follow-up procedures after a possible exposure to HIV/HBV
were not developed nor implemented.
3) Training for high risk health care workers was inadequate in that
employees had no knowledge of: all aspects of personal protective
equipment, "universal precautions", color coding, other methods used
in designating contaminated waste, precautions used in handling
contaminated articles or infectious waste, and procedures used when
exposed to a needlestick or to body fluids.
Some feasible and acceptable abatement methods among others to correct
these hazards are:
1) Provide training and education on the Universal Precaution system.
This training would be based on the fact that all patients would be
treated as infectious meaning all employees would be mandated to use
personal protective equipment for all procedures where potential
exposure to blood, body lfuids, and/or gingiral fluid would occur
(i.e., eye protection, surgical masks, gloves, etc..,).
2) Provide a policy that addresses all circumstances warranting
Hepatitis B vaccinations and identify employees at substantial risk
of direct contact with body fluids. Offer employees Hepatitis B
vaccinations in amounts and at times prescribed by standard medical
practice.
3) Follow CDC guidelines (Appendix B) "recommendations for prevention of
HIV Transmission in Health-Care Settings"; Management of exposures
for follow-up procedures after possible exposure to HIV/HBV.
4) Provide training and education on precautionary measures,
epidemiology, modes of transmission and prevention of HIV/HBV.
Provide counseling regarding possible risks of transmission to the
fetus of HIV/HBV and other infectious agents. Training and education
will also include providing information on personal protective
equipment, color coding, handling of infectious waste, and procedures
after exposure.
ABATEMENT NORMALLY WILL BE MULTI-STEP AS FOLLOWS:
STEP 1: Provide and ensure use of protective equipment to exposed
employees.
STEP 2: Submit to the Area Director a written detailed plan of abatement
outlining a schedule for the implementation of engineering and/
or administrative measures to control employee exposures to
hazardous substances referenced in this citation. The plan shall
include, at a minimum, target dates for the following actions
which should be consistent with the dates required by this
citation.
a) Evaluation of engineering/administrative control options;
b) Selection of optimum control methods and completion of design;
c) Procurement, installation and operation of selected control measures;
d) Testing and acceptance or modification/redesign of controls.
All proposed control measures shall be evaluated for each particular
use by a competent Industrial Hygienist or other technically
qualified person. Thirty (30) day progress reports are required
during the abatement period.
STEP 3: Abatement shall have been completed by the implementation of
feasible engineering and/or administrative controls and upon
verification of their effectiveness of achieving compliance.

Issued

Apr 7, 1989

Abate by

Apr 12, 1989

Penalty

Initial $140 · Current $140

Issued

Apr 7, 1989

Abate by

Apr 12, 1989

Issued

Apr 7, 1989

Abate by

Apr 10, 1989

Issued

Apr 7, 1989

Abate by

May 8, 1989

Issued

Apr 7, 1989

Abate by

Apr 17, 1989

Issued

Apr 7, 1989

Abate by

Apr 17, 1989

Issued

Apr 7, 1989

Abate by

May 7, 1989

Issued

Apr 7, 1989

Abate by

Apr 17, 1989