TOSHA 2025 Citation Roundup

Common Citations and how to avoid them

by Caitlin Denison, BS, RDH

It’s no secret that Tennessee OSHA (TOSHA) has been out and about making visits to dental offices across the state for the past few months. It’s also no secret that being unprepared for an inspection can be not only stressful for the staff and owners, but also financially damaging due to fines, and increases in payroll costs required by employees handling the complex abatement process. So, what has TOSHA been citing lately? Let’s take a look:

1. Removing or recapping needles without demonstrating that no alternative is available, or that such action was required by a specific procedure (29 CFR 1910.1030d(2)(vii)(A):

As one office manager told me, ‘TOSHA really seems fixated on the whole recapping thing!’ It was an astute observation. You can almost guarantee that a TOSHA inspector is going to be concerned, perplexed, or even upset about the routine and necessary process of recapping anesthetic needles.

The OSHA bloodborne pathogens standard specifically prohibits bending and recapping needles, unless this task is required. A TOSHA inspector who has not worked in dentistry, or who is more familiar with sharps used in medical facilities, is likely not going to understand that recapping and removal of needles is unavoidable in dentistry.

So, how do we avoid this citation? Ensure that your office’s exposure control plan (ECP) clearly outlines why recapping is performed. Key elements to note are that recapping protects the patient from unnecessary contamination and the employee from exposure. Now, the inspector’s next question might be, ‘Well, why not just dispose of the first needle and use a new one?’ To head this off, the ECP also needs to include an explanation of why a single needle, syringe, carpule apparatus is used multiple times on one patient. The reason is, of course, to provide anesthetic injections to multiple sites in the oral cavity.

• Failure to evaluate engineering controls 1910.1030(c)(1)(iv)(B):

As we discussed above, dental professionals frequently handle hazardous, contaminated sharps. Often, these devices are not ‘safer medical devices,’ meaning they do not have built-in safety features to prevent contaminated sharps injuries. In the past, this was because there were very few safer devices on the market; we simply did not have many options when it came to selecting safe equipment. However, thanks to recent innovations, we have access to a variety of ‘safer devices’ that can be implemented into daily practice. These devices include things like retractable scalpels, needle sheaths, and more. OSHA recognizes that new devices are constantly coming to the market, and wants employers to take advantage of this. Essentially, we don’t want offices getting stuck in the stone age using unsafe devices, simply due to lack of awareness about or research on new devices.

 To this end, OSHA requires that providers evaluate a new device that could minimize occupational exposure each year. Importantly, the employees who would use these devices must be included in this review. At Modern Practice Solutions, we provide clients with a compliant evaluation form and walk them through the evaluation during annual OSHA training. 

• Failure to use engineering or work practice controls to eliminate or minimize exposure (29 CFR 1910.1030(d)(2)(i)

This is typically cited in relation to recapping or removing needles. To avoid this citation, consider what work practices and engineering controls your practice has in place to protect employees during these tasks.

 Work practice controls include procedures like using a single-handed recapping technique (‘single-handed scoop’). Engineering controls include items such as needle recapping devices or devices that sheath the needle when it is not in use. I encourage every manager to ask themselves the question ‘are my employees using the safest method available for this task?’ If not, you likely need to consider implementing new procedures or devices. Remember, you want to be able to confidently explain to an inspector that you are doing everything possible to protect your employees.  

Ensure that your exposure control plan accurately details the procedures and controls in place at your practice. For example,  if dentists and dental assistants handle needles during a procedure, safety procedures need to include both users.

Please keep in mind, complying with these three items does not ensure your practice is compliant or will ace an inspection. There are dozens of standards to cite in the bloodborne pathogens regulation alone! A comprehensive compliance program, staff training, and appropriate procedures are the best way to ensure a smooth inspection.