Step by Step Compliance guide from Dr. Cesar Solano, Jr.

Dental Compliance in the Covid Era

All of you in the dental industry know this is like no other time we have experienced.  It is kind of scary as we are in unchartered waters dealing with Covid 19. 

Dentistry is one of the highest risk careers of exposure to the Covid 19 virus.  Given this possibility, newer guidelines for infection control prevention needs to be implemented in each office.

Dr. Cesar Solano, Jr. has given a step by step compliance guide to help you deal with the Covid 19 situation in your office.  Please see his recommendations below:

 

Standard Precautions will be the first thing everybody in the office would need to be reminded of:

1.    Hand hygiene

2.    Use of personal protective equipment (e.g., gloves, masks, eyewear) 

3.    Respiratory hygiene / cough etiquette 

 4.    Sharps safety (engineering and work practice controls

 5.    Safe injection practices (i.e., aseptic technique for parenteral medications)

 6.    Sterile instruments and devices

 

7.    Clean and disinfected environmental surfaces

But this will not be enough, not even close to enough. Changes will start from here on out. 

Some changes that may minimize risk: (this is in addition to what we already do)

 

Patient Check in and Scheduling

·       All paper work should be filled out online, before showing up to the office

 ·       In the event the patient does not have access to a computer, she or he will be given a form to be filled in a separate room with the door closed or the patient’s vehicle

  ·       Patient should be asked in a specific form if he or she has contracted Covid 19 or has been in contact with anybody diagnosed with Covid 19

 ·       Patients should come alone to their appointments unless they are being sedated or need a companion (Minors, special needs, etc.)

 ·       Anybody that is in waiting for a patient does not need to be in the operatory should wait in their vehicle

 ·       Patients should not spend more time than necessary in the waiting room

 ·       Patients should be scheduled with enough time that warrants complete sanitation of operatories – no double scheduling

  ·       Patients coming in the office should be offered hand sanitizer before touching anything  

 ·       They should spray the soles of their shoes and use shoe covers

 ·       Pens can be gifted in case the need to sign anything

 ·       Temperature should be taken before going back to the operatory

·       Patient should be evaluated for any flu like symptoms and signs. No patient with symptoms, no matter how mild, should be seen for elective treatment

 ·       Staff can walk the patient to the operatory room already using all mandatory, clean PPE

 ·       Once in the operatory with the patient, the assistant must stay in the room until the procedure is completed, discarding the PPE before leaving the room

 ·       Separate staff may be used only to bring in the operatory any material or instrument that may be needed to avoid having to change PPE

 

In the Operatory

·       Patient will be walked into the dental operatory and given a mandatory pre-rinse with a peroxide at minimum of 1% concentration for 60 seconds before starting any procedure (Colgate Peroxyl or Listerine Whitening)

·       No paper material of any kind should be in the operatory during treatment that uses sprays or aerosols

 ·       Every staff members and or provider in the operatory should be wearing all PPE once entering and should REMOVE SOILED PPE BEFORE EXITING

·       Once the patient is seated, it is recommended that no one should leave the operatory until the procedure is finished

 

Grooming of Dentist and Staff

·       No facial hair – according to the CDC, certain type of facial hair reduces the filtering capacity of respirators and masks

 ·       Long hair should be put up or shortened

 ·       Nails should be trimmed

 ·       No use of jewelry

  

Personal Protective Equipment

·       Critical masks: N95 respirators need to be custom fit when performing any treatment with aerosols and used in context to the complete Respiratory Protection Program

 ·       Non-critical masks: level 3 surgical masks may be used if it is a procedure with no aerosols

  ·       Gloves: Double Glove Technique should be used for all dental procedures – the outer glove should be disposed of before removing all other PPE.

 

  ·       Eye and Face Protection for Critical Tasks: Face Shield and Protective Glasses should be the standard in any procedure where aerosols are produced- should be cleaned with soap and water and when visibly soiled, disinfected with a disinfectant wipe between patients

 

·       Eye and Face Protection for Non-Critical Tasks: Protective glasses are fine 

  ·       Head Covers and Feet Covers: should be used while treating patients and discarded before leaving the operatory

 

·       Gowns for Critical Tasks: surgical gowns should be used with a level 3 or greater protective barrier

·       Gowns for Non-Critical Tasks: Non-surgical gowns should be used with a level 2 protective barrier

 

 Other Clincal Layer Precautions

·       Restorative treatment should be performed with a rubber dam or extra suction device

 ·       Disinfecting the teeth with hydrogen peroxide prior to treatment is recommended

 ·       Working in quadrants is recommended

  ·       High volume evacuator should be functioning during all treatment where aerosols are being generated

 ·       Amount of water should be reduced as much as possible

  ·       Equipment such as extraoral suction should be used

 

 ·       Operatory doors should be closed if possible

 ·       The use of UV lamps or negative pressure rooms would be ideal.

 

 Staff and Work Environment

·       No staff should come to work if sick or having flu like symptoms

 ·       Practice social distancing at work

 ·       Everybody should disinfect their shoes before entering the building

 ·       No one should wear their clinic attire or clinic shoes home

 ·       If office has an on-site washer and dryer, launder clinic attire at the office

 ·       If no onsite washer and dryer, clinic attire must be removed and placed in a sealed bag and washed separately with a disinfectant like Lysol for the laundry

 ·       Clinical staff should take a shower immediately when arriving home to remove any possible contaminates so as to not expose the family

 The main objective is to minimize risk of contamination.  By standard procedures to reduce the new encountered risk of Covid 19 infection.  By containing risk within the operatory during the dental procedure.