We continue to hear concern about anticipated regulations and cost associated with infection control in light of the COVID-19 pandemic. As a result, we have been seeking input from thought leaders in this arena to share insight and tactical guidance. We are pleased to present some information provided by Karen Daw, President of Karen Daw Consulting. We hope you will benefit from the information she graciously provided. If you have further questions, please feel free to reach out to her directly. You can reach her via her website https://www.karendaw.com/contact/.
Thanks for the opportunity to address these common questions and hopefully alleviate some concerns. Please know, this information is changing on a constant basis. Practices should refer to CDC, OSHA and ADA for the most current recommendations and regulations. Thanks too, for all of you who have made the sacrifices needed to protect our community and our brothers and sisters in the medical field.
What are the current guidelines for treating patients in emergencies?
I have a full-hour CE on the topic of current guidelines for treating patients in emergencies. Some of the main takeaways are to know the ADA definition of ‘emergency’ and communicate this with staff and patients. From the ADA website:Examples of urgent dental care treatments, which should be treated as minimally invasively as possible, include:
• Severe dental pain from pulpal inflammation.• Pericoronitis or third-molar pain.• Surgical postoperative osteitis or dry socket dressing changes.• Abscess or localized bacterial infection resulting in localized pain and swelling.• Tooth fracture resulting in pain or causing soft tissue trauma.• Dental trauma with avulsion/luxation.• Dental treatment cementation if the temporary restoration is lost, broken or causing gingival irritation.
Contact Karen Daw for more information
Other emergency dental care includes extensive caries or defective restorations causing pain; suture removal; denture adjustments on radiation/oncology patients; denture adjustments or repairs when function impeded; replacing temporary filling on endo access openings in patients experiencing pain; and snipping or adjustments of an orthodontic wire or appliances piercing or ulcerating the oral mucosa.Treating a patient that fits the scenario above requires certain modification to current practices, including screening the patient for active COVID-19 infection, social distancing in the waiting room, donning of appropriate eye and face PPE (either being medically fitted for N95 respirator or higher with protective eyewear, or ASTM level 3 surgical mask with full face shield) in addition to gown and gloves. In addition to PPE, ensure the team has received their annual flu vaccine. Continue to practice standard precaution and evaluate ways to minimize aerosols (dental dam, HVE, etc). If the patient is positive or suspected of having COVID-19, treat in a facility meeting droplet transmission standards.
Are dental practices going to be required to install negative air pressure systems?
Currently there are no requirements to do so for SARS-CoV-2. As of now, patients suspected of being positive for COVID-19 will need to be treated in facilities with negative air pressure systems. If it does become a requirement, it will first go through the approval process before it becomes law and there most likely will be a phase in period.
What would you recommend for proper cleaning protocols for the operatory?
Standard precautions still apply for decontamination of PPE, disinfection of surfaces and sterilization of instruments. For disinfection, use products with EPA-approved emerging viral pathogens claims.The EPA maintains a list of EPA-registered disinfectants that have qualified under EPA’s emerging viral pathogens program for use against SARS-CoV-2.
If you are not seeing patients, what should practices be thinking about and doing now before they reopen?
During this time some considerations to prepare for reopening might include:– Patient messaging around what you’re doing to ensure their safety,– Team training in safety and infection control,– Equipment maintenance,– Ordering supplies,– Waterline testing,– Scaling of the business to account for reduced or increased work load.
Fortunately, resources are in abundance and readily available to the dental community. Some of this can occur now, some will have to wait until you’re back in the practice.
Where should practices be looking for information?
Social media is a great place to catch the latest Tiger King meme, however, it can also be a source for spreading misinformation. Your safety consultant, webinars led by industry experts, and information directly from government agencies and organizations, with dedicated pages to coronavirus are the best placed to obtain credible information. Please see the links to the right.
CDC websiteOSHA websiteOSAP websiteADA website
Where is this headed? Fast forward a year from now. What changes?
I can’t say for sure, but there are changes coming as a result. For now, I would recommend:1. Having a written respiratory hygiene and protection program,2. Enhance the practice’s Exposure Control Plan and PPE certification,3. Evaluate additional work practice, engineering and administrative controls to include the assessment of new technology designed to minimize aerosol.
What bad habits in a typical office need to change right away?
Sending just one person to attend safety training and then expecting that person to cover everything with the staff. That’s a huge responsibility and burden placed on the shoulders of one person. Or trying to fulfill OSHA training solely online just to “check off the box”. This is a liability just waiting to happen.
Any closing thoughts?
We need to toss the notion that “We have a great (CDC, OSHA, safety) program. The saying, “You don’t know what you don’t know” is true now more than ever. Encourage the team to take part in ongoing infection control and OSHA training above and beyond the bare minimum. Expect and embrace the changes that will impact our industry. And, communicate that safety standards and best practices are a must. These will go a long way in creating a culture of safety.
Karen Daw is an award-winning national speaker, author of numerous articles and CE courses on safety in dentistry, and a consultant to practices across the country. She earned her BA from the Ohio State University and her MBA with concentrations in Healthcare Administration and Business Management. After graduating, Karen was recruited from the Emergency Department to her roles as Assistant Director of Sterilization Monitoring and Health and Safety Director for the OSU College of Dentistry. Karen draws on her rich background to educate audiences large and small on how NOT to do safety, and, best practices to avoid penalties, negative reviews and the 6 o’clock news! To schedule a virtual or in-office OSHA and Infection Control CE or consult, visit www.KarenDaw.com
Dental providers affected by COVID have a number of resources available to support their successful re-opening. CARES Act monies are available through August 3, 2020.
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