Cal/OSHA in 2009 adopted a regulation to prevent the transmission of aerosol transmissible diseases (ATDs) at health care facilities, including nursing homes, correctional facilities, homeless shelters and drug treatment programs, and among specific service providers, such as emergency responders. Aerosol transmissible diseases include influenza--all types, chicken pox, tuberculosis and several more listed in the regulation’s Appendix A (available at the end of this article). Most dental practices and many specialty medical practices are exempt from the regulation as long as the practices comply with specific conditions. The regulation can be found in Title 8 of the California Code of Regulations Section 5199.
Dental practices may be exempt from the regulation per Section 5199(a)(2). To be exempt, dental practices must comply with all of the following conditions:
CDA Practice Support has updated its sample Injury and Illness Prevention Plan to help your practice comply with the requirements.
Included at the end of this article are links to online resources that assist dental practices in developing a patient screening protocol and a copy of the regulation’s Appendix F, which contains sample screening criteria.
A dental practice that does not comply with the conditions for exemption from the regulation is a “Referring Employer” under Section 5199. A referring employer must (1) screen individuals for airborne infectious diseases (AirID); (2) refer any person identified as a case or suspected case of AirID; (3) not intend to provide medical services to AirID cases and suspected cases other than first aid; and (4) not provide transport, housing, or airborne infection isolation, as defined in the regulation, to any person identified as an Air ID case or suspected case, unless the transport provided is only non-medical transport in the course of a referral.
A Referring Employer is required to comply with subsection (c) Referring Employers and subsection (j) Recordkeeping of the regulation. A copy of these two sections is provided below.
In facilities, services, or operations in which there is occupational exposure and which meet the criteria specified by (a)(3)(A), employers are only required to comply with the following provisions:
This appendix contains a list of diseases and pathogens which are to be considered aerosol transmissible pathogens or diseases for the purpose of Section 5199. Employers are required to provide the protections required by Section 5199 according to whether the disease or pathogen requires airborne infection isolation or droplet precautions as indicated by the two lists below.
This appendix contains sample criteria to be used by non-medical employees for screening purposes in settings where no health care providers are available. Coordination with local health departments, including TB control programs, may be necessary for the success of this referral policy. Employees should be instructed in how clients’ privacy will be maintained during screening procedures.