SS-B_Dental.Survey_13IF_072613

A Pilot Project to Evaluate the Use of Bloodborne Pathogens

Exposure Control Plans in Private Dental Practices

Request for Office of Management and Budget (OMB) Review and Approval

for a Federally Sponsored Data Collection

Section B

James M. Boiano, MS, CIH

Project Officer

[email protected]

National Institute for Occupational Safety and Health

Division of Surveillance, Hazard Evaluations and Field Studies

Surveillance Branch, Mail Stop R-17

4676 Columbia Parkway

Cincinnati, OH 45226-1998

July 15, 2013

513-841-4246 (tel)

404-929-2646 (fax)

2. COLLECTIONS OF INFORMATION EMPLOYING STATISTICAL METHODS

To evaluate the extent of use of exposure control plans mandated by OSHA’s Bloodborne Pathogens (BBP) Standard, a web survey of private dental practices in the United States is planned. Information collected will include evaluating the extent of use of existing exposure control plans; whether the plan or other resources are actively used to prevent occupational exposures; available resources and barriers to use such as relevant education materials, knowledge, costs and availability; and descriptive information on the type, size and geographic location of the dental practice. Information collected will be used to develop strategies to overcome key barriers to compliance, to guide health and safety promotion, interventions, and future research.

B1. Respondent Universe and Sampling Methods

According to the American Dental Association (ADA), in 2009 there were 186,084 dentists in the United States including 170,694 (92%) in private practice.¹⁰ Nearly one-third of dentists were self-employed and not incorporated. According to the ADA, about three out of four dentists in private practice are sole proprietors with 15% belonging to a partnership. Very few salaried dentists worked in hospitals and physician offices.

OSAP is working with a publishing partner, Aegis Communications, who maintains a double-opt-in email distribution list of 49,172 general dentists and dental specialists in the U.S. The list represents nearly 30% of the total population of private practice dentists and will serve as the sampling frame. Dentists on the list represent general dental practices (78%) and specialty practices (22%). Specialty practices include: oral and maxillofacial surgeons, pediatric dentists and periodontists. Other dentist specialists including endodontists, oral pathologists, orthodontists, prosthodontists and public health dentists will not be included in the sample because they either do not work in private practice and/or were at relatively low risk of exposure to BBPs.

The email invitation with a link to the survey will be sent by Aegis Communications to 40,575 dentists and dentist specialists in the survey sample. We estimate that 20,287 dentists receiving the email will complete the survey, assuming a 50% participation rate which is based on a 2008 survey of dentists where researchers reported a 49% response rate using a paper survey.¹¹

B2. Procedures for the Collection of Information

Following OMB approval, the OMB approval number and expiration date will be displayed on the introductory page of the survey. OSAP will work closely with Aegis Communications to ensure timely delivery of a series of survey communications to the sampled dentists. The emails will provide information on the survey sponsor; purpose of the survey; importance to the dental profession of the information to be collected; estimated completion time; voluntary and anonymous participation; secure nature of responses; and contacts for questions. The types of communications and timelines are as follows:

• 10 days before survey launch date – pre-survey notification (Attachment E)

• Survey launch date – survey invitation (Attachment F)

• 10 days post survey launch date - first reminder (Attachment G)

• 20 days post survey launch date - second reminder (Attachment H)

• 25 days post survey launch date - final reminder (Attachment I)

The data collection period of the survey will be four weeks. The invitation and reminder emails to be sent during this 4 week period will contain a link to the survey where respondents will be directed upon clicking the link. The dentist or a key alternate respondent in each of the dental practices are expected to complete the survey.

B3. Methods to Maximize Response Rates and Deal with NonResponse

Healthcare workers are well educated and familiar with computer technology and the Internet. The dentists in the distribution list are periodically contacted to gather information using web surveys, and the survey population is expected to be very comfortable with this mode of data collection. To maximize participation, a series of emails (i.e., pre-survey notification, invitation email, and three reminder emails) will be sent to invitees. The emails will emphasize the importance of the survey: for improving utility of exposure control plans for reducing the risk of exposure to blood in private dental practices. Similar information will also be included on the introductory page of the web survey.

B4. Tests of Procedures or Methods to be Undertaken

The content of the survey questionnaire was developed over several iterations following discussions with stakeholders, subject matter experts, and dental practitioners.

A total of 9 cognitive interviews with active dental office team members (dentists, dental assistants and dental hygienists) were conducted. Participants were recruited by the project’s advisory committee members from dental practices in three states in different regions; from rural, suburban and large cities; from a solo general dentist or specialist-owned practice to large multi-specialty group practices. Participants completed the questionnaire and then answered field test questions about their process in answering the survey questions, including the time involved. The field test questions gathered detailed information about how well respondents were able to understand and answer individual survey questions, with the goal of identifying and removing potential sources of response error. Comments from the field tests resulted in: 1) rewording of a few questions to improve clarity; 2) including one or two more response options for some questions, and 3) making sure instructions are clear about what an exposure plan is. Participants indicated the survey was comprehensive and a good learning experience. Survey completion time was about 15 minutes.

A pre-test of the web survey will be conducted in (May/June 2013). The primary purpose of the pre-test will be to evaluate the usability of the web-based survey, ensure that the programmed functions (i.e., skip patterns) are accurate and complete. We do not anticipate any changes to the content of the questions as a result of the pre-test of the web survey.

B5. Individuals Consulted on Statistical Aspects and Individuals Collecting and/or Analyzing Data

NIOSH has contracted with OSAP for technical assistance with this study. OSAP has developed the survey questionnaire, conducted cognitive testing of the paper instrument, and following OMB approval, will program and conduct usability testing of the web survey, prior to conducting the survey.

Project personnel from OSAP:

Therese Long, MBA, CAE [email protected]

Executive Director

(410) 571-0003

Beverly Isman, RDH, MPH, ELS [email protected]

Project Manager

(530) 758-1456

Shira Kramer, PhD

President

Global Epi Research [email protected]

800-511-1659

Ms. Karen Auiler

VP of Operations [email protected]

Aegis Communications

215-504-1275

Project personnel from NIOSH:

Jim Boiano, MS, CIH [email protected]

Senior Industrial Hygienist

(513) 841-4246

Susan McCrone, PhD, PMHCNS-BC, RN [email protected]

Coordinator, HCSA Program

(304) 285-6095

This collection of information does not employ statistical methods.

Literature Cited

1. Occupational Safety and Health Administration (OSHA), Revision to OSHA Bloodborne Pathogens Standard – Technical Background and Summary, (2001) on http://www.osha.gov/needlesticks/needlefact.html (visited January 21, 2013).

2. Needlestick Safety and Prevention Act of 2000, Pub. L. No. 106-430, 114 Stat. 1901 (Nov. 6, 2000).

3. Gershon, RM, Qureshi KA, Gurney CA, Rosen JD and Hogan EK (2002). Bloodborne pathogen exposure risk for non-hospital based healthcare workers. Clinics in Occupational and Environmental, 2:,497–518.

4. Lehman EJ, Huy JM, Viet SM, Gomaa A (2012). Compliance with bloodborne pathogen standards at eight correctional facilities. J Correctional Healthcare, 1: 29-44.

5. US Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health (NIOSH). State of the Sector |Healthcare and Social Assistance: Identification of Research Opportunities for the next Decade of NORA. DHHS (NIOSH) Publication Number 2009-139. http://www.cdc.gov/niosh/docs/2009-139. (visited January 21, 2013)

6. US Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health (NIOSH). NORA Healthcare and Social Assistance Research Agenda, December 21, 2009. http://www.cdc.gov/niosh/nora/comment/agendas/hlthcaresocassist/pdfs/HlthcareSocAssistDec2009.pdf (visited January 21, 2013)

7. Amendment to SurveyMonkey Terms of Use Applicable to U.S. Government Users and Subscribers, December 12, 2011 http://www.surveymonkey.com/mp/policy/terms-of-use-government/ (visited January 21, 2013)

8. Catalano JD, Knott C, Heyer N, Payn B. A Feasibility Evaluation of Tools and Methods for Surveillance of Health and Safety Hazards in Hospitals. Battelle Centers for Public Health Research and Evaluation, Seattle, WA. NIOSH Contract No. 200-2000-08018, Task Order 5, June 27, 2006.

9. Bureau of Labor Statistics, U.S. Department of Labor, May 2011 National Occupational Employment and Wage Estimates. http://www.bls.gov/oes/current/oes_nat.htm. (visited March 14, 2013).

10.American Dental Association. Frequently Asked Questions, http://www.ada.org/1444.aspx (visited March 14, 2013)

11.Cleveland JL, Foster M, Barker L, et al. (2012). Advancing infrction control in dental casre settings: factors associated with dentists’ implementation of guidelines from the Centers for Disease Control and Prevention. JADA, 143 (10):1127-1138.