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Reopening a dental practice during a pandemic is an unprecedented event. What infection control measures should occur and what infection control measures must occur to reassure patients and staff that they are in a safe environment due to the possible risk of infection of Coronavirus Disease (COVID-19)?
As DSOs open their dental practices, patients will be more observant, scrutinizing and willing to ask questions regarding cleanliness, protocols and use of personal protective equipment (PPE) worn or not worn by healthcare workers within your office. Dental practices which have an organized infection prevention and control program that follow CDC Guidelines for standard precautions, will have minimal changes to tweak when addressing the concerns expressed by both patients and staff compared to dental practices having minimum infection prevention and control guidelines with standard precautions.
Standard precautions (SP) are CDC guidelines to reduce the risk of transmission of bloodborne pathogens and other pathogens from recognized and unrecognized sources. The CDC recommendations reduces an employee risk to pathogens through education, training, use of personal protective equipment (PPE), availability of PPE and the donning and doffing of PPE. Standard precautions establish guidelines for the safe use of sharps, disposal of sharps and availability of sharps with passive safety devices. There are recommendations for appropriate cleaning of soiled equipment, disinfection and sterilization including environmental cleaning, disinfection, disposal of medical waste and performing hand hygiene.
For decades, clinical infection preventionists (CIPs) have been an overarching resource within hospitals. Oversight by a trained clinical inspection preventionist is recommended for dental groups and DSOs. Smaller dental group practices would benefit with two to three visits per year with a CIP. Whether your group is large or small, you will want to have a CIP or some type of expert who is advising and setting protocols.
An infection control must for dental group practices or DSOs post COVID-19 is an infection control risk assessment (ICRA). An ICRA utilizes a standardized logarithmic equation to calculate an infection control risk as being either low, medium or high. A risk assessment is a must for all dental practices and DSOs that want to achieve a higher level of patient and staff safety. This risk assessment will also assist in organizing and standardizing infection prevention and control practices throughout an organization. The use of an ICRA identifies the risk of various infection control criteria that could potentially impact a DSO. Categories within the risk assessment include:
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- procedure related practices
- disinfection
- sterilization
- bloodborne pathogen
- communicable disease transmission.
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The ICRA summarizes the probability of an event occurring while assessing each infection control category separately including a score for risk severity. From the risk assessment, a risk factor is calculated indicating the severity effect. A DSO can determine what infection prevention and control measures need remediation and what infection control standards have been successfully implemented and achieved. This infection control risk assessment is very useful to identify the infection prevention strengths and weaknesses within an office practice or organization.
As DSOs and dental groups reopen their practices amid COVID-19, here are 11 recommendations that your dental offices should do now:
1. Universal source control masking – employees wear surgical masks and patients wear cloth or surgical masks upon arrival and in waiting areas.
2. Social distancing – rearrange seating in waiting areas so patients, visitors and escorts are minimally three to six feet apart. Six feet separation may not be feasible in all waiting areas. If possible, limit the number of visitors and escorts in waiting areas to achieve social distancing.
3. Pre-screen patients, visitors, escorts and staff for signs and symptoms of COVID-19 upon entry to the building and/or office suite.
4. Signage displayed at building entrances and waiting areas indicating the signs and symptoms of COVID-19.
5. Patients with signs and symptoms of COVID-19, reschedule appointment. If rescheduling is not possible, schedule patients for last appointment of the day and escort directly to operatory.
6. Provide tissue and hand sanitizers in waiting areas, post and display hand hygiene signs.
7. Ask patients or visitors wearing exam gloves to remove and dispose of gloves and perform hand hygiene.
8. Remove pens and clipboards if possible and use electronic signature pad. Use disinfected wipes to clean pens, clipboards and E-signature pad after each patient use.
9. Remove magazines in waiting areas and procedure rooms. If previously available, remove TV remote control in waiting areas.
10. Disinfect high touch surfaces such as, door handles, countertops, dental chairs, trays and cup holders.
11. Have dental healthcare workers escort patients to rooms and open doors for the patient.
Written by John Torresan. John is semi-retired and former head of infection control at the largest health system in Michigan. Prior to infection control, John was a lab supervisor in microbiology for 18 years. During his tenure within infection prevention and control, John has implemented policies and programs to reduce or prevent hospital acquired infections in the hospital organization, advise nurses and doctors, and participated in state-wide programs. John can be reached at jptorresan@icloud.com
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