Updated March 15, 2020
As small practice business owners, leaders and health care providers, I encourage you to be as transparent as possible with your team members and patients. In this time of turmoil, establish a clear and accurate communication system so that everyone involved is aware of what steps are taken to protect your employees, patients, and their loved ones. Take control of the situation. Working with infectious pathogens is nothing new to the dental care professional. We are aware that most respiratory viruses have the potential to be lethal. This is in no way an effort to downplay the magnitude of the current situation, but rather to help you put things into perspective. In 2019, the influenza virus claimed 30,000 lives and our workflow managed to be unaffected. To date, 57 people have died due to COVID-19 and the media reported every single one inadvertently causing panic and fear. Currently, most dental offices are experiencing high levels of no shows/cancellations and numerous team members have expressed concern for the lack of concise guidance in this time of need. In an effort to alleviate some panic and confusion please consider the following dental industry-specific recommendations based on the most recent information regarding COVID-19 from OSHA, the ADA, and CDC.
1. Stay informed about your local COVID-19 situation
2. Update your Scheduling protocol
3. Uphold Standard Precautions as recommended by the CDC.
4. Execute Infection control protocols accurately
5. Don correct personal protective equipment
6. Practice excellent hand hygiene
7. Follow new social distancing recommendations
8. Feel safe to perform daily duties.
9. If you are sick, stay home.
Monitor local situation
If you find your area is experiencing a cluster of outbreaks, seize all non-essential treatment for at least two weeks.
Have an honest conversation with each of your team members. Make sure they feel safe to continue to perform their daily duties. Some team members may face personal circumstances that no longer allow them to safely come into work. Circumstances such as undisclosed health conditions, no child care, immunocompromised family members. If that is the case, do your best to accommodate their absenteeism.
Create or update emergency contact list for all team members.
There is a global shortage of infection control products and personal protective equipment. It is recommended that each office maintain and check their inventory every day. If you run out of the necessary personal protective equipment you are required to seize all operations until adequate supplies are replenished. Unfortunately, some offices have experienced theft from employees and patients. Communicate with your team members that products in the office are for in-office use only and keep supplies out of sight when treating patients. Under no circumstance is it acceptable to reprocess single use disposable items.
Avoid handshaking. If you forget and you handshake, wash your hands immediately.
Keep a reasonable distance between you and others.
If you feel sick, stay home.
Patient screening needs to begin on the phone before the patient is in the office.
Sample Script: Mr. Smith, please know we are taking all necessary measures to help protect the safety and health of our staff and patients during this time. Out of an abundance of caution, we are asking some routine questions:
1. In the last 24 hours have you experienced any signs of a fever, runny nose, cough, wheezing or shortness of breath or any flu-like symptoms?
2. In the last 14 days have you travelled on an international flight or been on a cruise?
3. In the last 14 days have you traveled on a domestic flight?
4. Have you been directly exposed to a known COVID-19 positive patient?
5. Are you over the age of 60?
6. Do you have any conditions that would cause you to be immunocompromised?
If a patient answers “yes” to any of the above questions, it is recommended to reschedule any elective/non-essential appointments for at least 14 days.
The same screening needs to take place at check-in.
Consider checking temperature with a touchless thermometer.
If a patient presents with symptoms of respiratory infection or fever, please reschedule at least 14 days.
Ask patient to use hand sanitizer and perform a hydrogen peroxide pre-procedural rinse. In an article published by the International Journal of Oral Science, a study found that a hydrogen peroxide based pre-procedural rinse significantly lowered the Corona Viral load, unfortunately a chlorhexidine based pre-procedural rinse did not result in similar findings.
Whenever possible limit the use of cavitron, piezo, or use high speed suction.
Standard precautions were established by the CDC and are more encompassing than Universal Precautions. Assume that every person is potentially infected or colonized with a harmful pathogen that could be transmitted in the healthcare setting and apply the following infection control practices:
This week the CDC implemented interim guidelines and recommends two consecutive 20 second hand washes before and three consecutive 20 second hand washes after treating the patient. Use anti-microbial soap and completely dry your hands with a disposable towel. When washing hands pay close attention to the area in-between your fingers, around your nails, and your wrists. If hands are not visibly soiled using hand sanitizer with Ethyl Alcohol range between 61-72% is acceptable. When using the hand sanitizer rub your hands meticulously until completely dry, never towel dry your hands.
Practice frequent hand washing
Personal Protective Equipment
Wear appropriate personal protective equipment for all procedures. Typically that includes an ASTM Level 3 surgical mask (color side out) or an N95 mask (you must be fitted for), impermeable buttoned-up gown and eye protection with solid side shields or a face shield to protect mucous membranes of the eyes, nose and mouth during procedures with anticipated spatter of blood or other potentially infectious materials.
Change masks between patients or sooner if they become wet.
It is never acceptable to reuse or reprocess masks or any other personal protective equipment designed for single use only.
Never launder contaminated personal protective equipment at home. Use disposable buttoned up knee length gowns, launder on site, or utilize a laundry service.
Bring a change of shoes; leave your work shoes at work.
Researchers have reported that the Corona virus can stay alive on surfaced from 4 hours to 9 days. It is at the up most importance to keep all surfaces clean and sanitized. The operatories need to be clean and disinfected using an OSHA approved hospital grade disinfectant such as the CaviWipes Bleach Disinfectants. It is acceptable to use EPA approved disinfecting wipes or other surface cleaners in the waiting rooms and other common areas. Always follow Manufacturer’s instructions for use.
Do not touch your face, mouth, or eyes.
Avoid touching high-touch surfaces with bare hands. If you must wash hands as soon as feasible.
Practice proper cough etiquette put forth by the CDC.
Remove all magazines, toys, books, and any other non-essential items. Wipe down all handles, light switches, high touch areas routinely.
Front desk team members need to maintain a proper social distance from patients; 6 feet away from symptomatic patients and 3 feet away from non-symptomatic patients.
Routinely wipe down and disinfect phones, keyboards, countertops, It is acceptable to use household EPA approved disinfectants.
Peng, Xian & Xu, Xin & Li, Yuqing & Cheng, Lei & Zhou, Xuedong & Ren, Biao. (2020). Transmission routes of 2019-nCoV and controls in dental practice. International Journal of Oral Science. 12. 9. 10.1038/s41368-020-0075-9.
It is important to understand that the recommendations outlined are subject to change as the situation develops. Dominika with Innovative Dental Consulting is a safety compliance trainer for dental offices. She is working diligently to stay abreast the most current information as it develops. As always feel free to contact her at: [email protected]