OSHA Inspection: GIL CAVER, DDS

Issued

Jan 30, 1995

Abate by

Jan 31, 1996

Penalty

Initial $750 · Current $100 Reduced

Hazardous substances 1953

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:
On site, employees performing or assisting in dental procedures where
nitrous oxide was
administered to patients as an anesthetic gas, were exposed to the waste
nitrous oxide gas
in levels exceeding the recommended exposure level (REL) of 25 parts per
million
(PPM) as an 8-hour time weighted average (TWA).  The REL was established
by the
National Institute of Occupational Safety and Health (NIOSH), U.S.
Department of
Health and Human Services to protect employees from the harmful health
effects of
nitrous oxide including reduced fertility, spontaneous abortions, and
neurologic, renal,
and liver disease.
Air monitoring conducted on 10-31-94 indicated employee exposure to
airborne nitrous oxide
as listed in the following table:
Job TitleTotal Sample TimeActual Exposure Level8-Hour TWA
in Minutes(PPM)(PPM)
Dentist59 483.00 59.4
Dental
Assistant58896.00108.3
Feasible and effective abatement methods can include, but are not limited
to the following:
Engineering Controls:
1.Perform additional monitoring of nitrous oxide levels, including
monitoring of air from
the workers personal breathing zone.
2.Leak test all equipment, including cylinder connections, distribution
and recovery
(scavenger) lines, seals, etc.  Exposure to nitrous oxide and repeated
sterilization can
degrade rubber and plastic  components.
3.If not completed, install a nitrous waste gas scavenger system.
4.Supply scavenging mask in a variety of sizes so that the mask fits
correctly over the
patients face, forming a comfortable and secure fit.
5.Make sure that the scavenging system exhaust rates (flow rates) are
approximately 45
liters per minute (L/min) to minimize nitrous leakage.  Monitor the flow
rate with a
flowmeter that is:-Validated to measure air flow within 5of actual air
flow,
-Permanently connected to the scavenging system vacuum line, and
-Positioned so that it is always visible to the operator.
6.Vent nitrous oxide from all scavenging pumps to the outside of the
building away from
any fresh air intakes, windows, or walkways.
7.Increase the air flow into the room(s) or increase the percentage of
outside air to allow
for more air mixing and further dilution of the anesthetic gas.  Maintain
a balanced air
supply and exhaust system so that nitrous does not contaminate adjacent
areas.
8.Consider the use of supplementary local ventilation (such as a vent
hood) in conjunction
with a scavenging system to reduce nitrous exposures in the operatory.
The effectiveness
of this type of ventilation may depend on its location with respect to the
patient and the
airflow rates.  Do not work between the patient and the exhaust duct, where
contaminated air would be drawn through the workers breathing zone.
Work Practice Controls:
1.Do not turn on the nitrous delivery system until:
-The vacuum system scavenging unit is operating at a flow rate of at least
45
L/min, and
-The scavenging mask is securely over the patient's nose or face.
2.Assure the mask is fastened according to the manufacturers instructions
to reduce
leakage.
3.Flush the system of nitrous after the procedure by administering oxygen
to the patient
through the anesthetic equipment for at least 5 minutes before
disconnecting the gas
delivery system.
4.Encourage the patient to minimize talking and mouth-breathing during
dental procedures.
Respiratory Protection:If levels can not be maintained below 25 parts per
million as an
8hour
time weighted average, the following controls should be considered:
1.Wear air supplied respirators.  If respirators are used, the employer
must comply with
the provisions of the OSHA Respiratory Protection Standard, 29CFR 1910.134.
Abatement Disclaimers:
1.The employer is not limited to the abatement methods suggested by OSHA.
2.The abatement methods explained are general, and may not be effective in
all cases.
3.The employer is responsible to selecting and carrying out an appropriate
abatement
method.

Issued

Jan 30, 1995

Abate by

Feb 24, 1995

Penalty

Initial $450 · Current $120 Reduced

Issued

Jan 30, 1995

Abate by

Feb 24, 1995

Issued

Jan 30, 1995

Abate by

Feb 24, 1995

Issued

Jan 30, 1995

Abate by

Feb 24, 1995

Penalty

Initial $750 · Current $263 Reduced

Issued

Jan 30, 1995

Abate by

Feb 24, 1995

Penalty

Initial $1,050 · Current $368 Reduced

Issued

Jan 30, 1995

Abate by

Feb 24, 1995

Issued

Jan 30, 1995

Abate by

Feb 24, 1995