Standard Interpretations - Table of Contents|
| Standard Number:||1910.1030|
July 3, 1997
Robert Chavez, D.D.S., M.S.
750 Almar Parkway
Bourbonnais, Illinois 60914
Dear Dr. Chavez:
Thank you for your letter dated May 8, regarding concerns about the Occupational Safety and Health Administration's (OSHA) standard for Occupational Exposure to Bloodborne Pathogens. In your letter you have stated an objection to wearing latex gloves while performing procedures in your orthodontic practice. You state that there is no contact with the teeth, gums or salvia of a patient in many of your procedures.
As you know, the standard requires that employees use gloves in the dental setting when there is hand contact with blood or "other potentially infectious material" (OPIM) which includes saliva in dental procedures as well as any body fluid that is visibly contaminated with blood. The use of gloves for examination of mucous membranes (including the mucous membranes of the mouth) was first recommended by the Centers for Disease Control and Prevention (MMWR, 1988; 37:379). Based on this recommendation, OSHA included this provision in the final standard. At a minimum, gloves must be used where there is reasonable anticipation of employee hand contact with blood or OPIM, or non-intact skin.
A section of the standard requires that employers provide gloves in the appropriate size. You state that "cheap, ambidextrous latex gloves" has caused two problems, allergic reactions to latex and carpal tunnel syndrome. Using the correct sized glove would help to eliminate some of the discomfort and help to promote employee participation. Some employees are allergic to latex. The alternatives to latex gloves include vinyl gloves, hypoallergenic gloves, glove liners, and pow[d]erless gloves.
Employees who are allergic to the gloves should be provided with one of these alternatives. The U.S. Food and Drug Administration (FDA) is finalizing a new labeling regulation to address the allergen problem with latex gloves in the health care setting. The use of gloves as means of protecting employees in the dental setting is not a new concept. According to the information provided to OSHA during the rulemaking, disposable gloves were in use by 96% of the direct patient care workers in dentists' offices before the standard became final.
We hope this information is responsive to your needs. If you have further questions, please feel free to call the Office of Health Compliance Assistance at (202) 219-8036.
John B. Miles, Jr., Director
Directorate of Compliance Programs
May 8, 1997
Mr. Joseph Dear
Department of Labor
200 Constitution Avenue, NW
Washington, D.C. 20210
Dear Mr. Dear:
As a healthcare professional, I feel obligated to write to you about the growing dissatisfaction with one part of "universal precautions", the gloving of the hands for every dental procedure. I want to add my voice to what I hope will increasingly become a loud chorus pressing for much needed change.
My practice is limited to orthodontics. Our procedures are bloodless. We do not use needles, scalpels or any other instruments designed to incise or penetrate soft tissues. Many of our procedures are completed in a few seconds, the gloved hand contacts the face and lip, but no contact is made with the teeth gums or saliva of the patient.
The imposition of "universal precautions" was well intentioned, but now we are seeing some very bad consequences resulting from the use of latex gloves. The latest article which I recently read disclosed that thus far one hundred and one people having died as a result of their contact with latex. Many others have not died, but they have been severely disabled by their contact with latex. Add to this the growing number of dentists disabled by carpal tunnel syndrome brought on by the restriction of normal finger movements experienced when using cheep, ambidextrous gloves. Before the AIDS problem surfaced, several million gloves were used, by healthcare workers each year. Today several billion gloves are used annually. Because of this tremendous increase in the use of latex gloves, the health problems associated with their use are also multiplying. The question becomes: is OSHA protecting or harming the general public and the healthcare workers by insisting on gloving for all procedures? This situation seems to be yet another case of the well intentioned causing significant harm.
Public paranoia based on ignorance and leading to great harm has been an ever present danger through the ages. For example, the early history of this country saw witches rounded up and burned alive. The public officials who carried out these horrible and mistaken acts did so at the prompting of an ignorant and paranoid public, and the officials were convinced that they were protecting the public.
I recall the Ryan White case. This grade school student was infected with the AIDS virus by being injected with blood products contaminated with the AIDS virus. The public furor, based upon fear and ignorance, forced him to leave his school. When finally the furor died down, and knowledge and understanding replaced fear and ignorance, he was allowed to return to his regular classroom. It was finally understood that his classmates would not become infected with AIDS if he kissed them or sneezed on them. They could drink out of his cup without becoming infected.
Thankfully, the AIDS virus, and thousands of other microorganisms which we swallow everyday with our food and drink, does not survive in the human digestive system. A recent article described an attempt to obtain live AIDS virus from the saliva of full-blown AIDS patients without success. The AIDS virus is attenuated or killed by salivary enzymes.
Contrast the AIDS problem with an outbreak of food poisoning in a restaurant. That bacteria, Salmonella typhosa, does survive in the human digestive system, and weaker individuals do die from ingesting this bacteria. However, this is an older problem which came to public attention before OSHA was in existence and before rubber gloves were easily available. The simple solution back then was to wash the hands after using the bathroom. This simple and sensible precaution eliminated the problem.
Can the AIDS virus be washed off the hands as easily as can Salmonella typhosa? It certainly can, and even if this virus remained on the fingers and was introduced into the mouth, this virus does not survive in the human digestive system. We should understand by now that this is not the mode of infection with this virus.
Had the apparently deliberate infection of several people in the Florida dental practice (Dr. Acer) not occurred, we still would have the AIDS problem, but without all of the multitude of new regulations that have descended like a plague on the practice of dentistry. While practicing dentists comply with the regulations, OSHA does not have the confidence and approval of dentists that these regulations are the proper, scientifically based, response to the original problem, but that they merely represent an odius and unnecessary intrusion, by well intentioned public officials, into the practice of dentistry. Since the beginning of the AIDS problem and before and after the new regulations, no further AIDS infections have occurred in the dental office in billions of dental appointments!
The requirement to glove the hands for all dental procedures is a direct result of the AIDS problem. All other health problems were present before the AIDS problem with no requirement for gloving. In view for the fact that gloving in dentistry is having no impact on the AIDS problem, but much harm (death and disability) has occurred and is increasing directly as a result of latex gloving, now is the time to reconsider the doubtful wisdom of continuing the gloving requirement except, of course, when surgery is being performed.
I respectfully request that you thoughtfully consider the ideas that I have expressed in this letter, and I hope that you will communicate with me in the near future.
Robert F. Chavez, D.D.S., M.S.
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