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  • by: Leslie Canham, CDA, RDA, CSP
  • 10 min read

COVID-19 and Infection Control in Dentistry

One of the biggest challenges for dental practices has been keeping up with all the rules and guidelines from the CDC, OSHA, ADA, OSAP, and federal, state, and local government officials.

 

Leslie Canham, CDA, RDA, CSP, is one of the top infection control experts in the nation. In this video, she talks to Patient Prism CEO Amol Nirgudkar about what dentists and team members need to know to reduce the risk of infection and perform dental services safely.

Leslie breaks it all down and shares the resources that will help practices the most. A list of those is included at the bottom of this article.

Patient Prism has also created a "Staying Safe in the Dental Practice" guide that you can download and share.

In the video, Leslie Canham provides wonderful guidance and advice on what steps the dentists and team members should be taking to protect themselves and their patients. Below is a short recap.

 

PPE: What to Wear

One of the biggest changes to PPE is that OSHA now requires dental workers to wear NIOSH-certified, disposable N95 filtering facepiece respirators or better and goggles or face shields when performing dental procedures that may or are known to generate aerosols. (Click here for OSHA guidance)

Team members should also wear an isolation gown or disposable gown over their scrubs.

“It’s a warmer environment, so we have to get used to a little more bulk,” said Canham. “You also need to know how to properly don the PPE and how to remove them. It takes a little extra time.”

 

Clinical Changes During COVID-19

This is a new infection so the information about how to prevent spreads is evolving.

The CDC recommends avoiding aerosol-generating procedures whenever possible. Specifically, it recommends avoiding the use of dental handpieces, ultrasonic scalers, and air-water syringes.

Instead, it recommends hand instruments only.

“I would start with going back to the basics of using a rubber dam when possible,” said Canham. “Another way to control aerosols is by proper use and positioning of the high-velocity evacuator. Also maintain the vacuum lines so they really work well and can channel the aerosols with efficiency.”

Another idea is to explore the use of air filtration systems, HEPA filters, extra-oral dental aerosol extractors, UV light, and other types of air purification systems. There may be options your air conditioning HVAC engineer can recommend.

As scientists and healthcare professionals are learning more about effective ways to stop the spread of COVID-19, the interim guidance will change. It may be good to have somebody in the practice assigned to checking the CDC, OSHA, OSAP and ADA websites weekly to make sure your dental practice is up-to-date on the newest information.

 

What Your Dental Patients Will Expect

  1. Pre-Visit Screening: Call patients the day before their appointments to screen for any signs of illness or contact with people who have been feeling sick or diagnosed with COVID-19. Click here for the ADA’s checklist of questions to ask.
  2. Safety Protocol Information: This is a good time to be contacting patients to let them know your operating hours and the extra safety precautions you’re taking to protect them and your team.
  3. Clean and Disinfected Office: Health and safety is top of mind for everyone, and people may be more critical than ever of your housekeeping skills. Now’s a great time to do a deep clean of the practice and make sure there’s no dust on the floorboards or air vents. Plus, assign a team member to regularly disinfect surfaces in the reception area, the restroom, and the check-in and check-out areas. For a list of disinfectants to use against COVID-19, click here.
  4. Temperature Checks: Many companies, not just healthcare providers, are performing temperature checks when people enter the premises. The results should be recorded in the patient’s file.
  5. Physical Distancing: Patients are going to expect to be physically separated by at least six feet from other patients. That means fewer chairs in the waiting room or protocols where people wait in their cars until you call them to say it’s time to go into a treatment room.
  6. Follow-Up Calls: Contract tracing is an important part of tracking the potential spread of infection. “Another very important thing to do is contact the patient within 14 days of their visit to see if they’re exhibiting any signs,” said Canham.  

Canham suggests having a “dress rehearsal” to have everyone get used to the new PPE protocols, disinfectant measures, and patient workflow.

 

When May Things Return to Normal?

Dentistry has adapted to infectious diseases before.

“My hope is that when we have a vaccine, better and faster testing, and maybe even more of a herd immunity, that we will be able to return to our pre-COVID days. We'll still need to screen patients for potentially infectious aerosol-transmissable diseases, like chicken pox, shingles, measles, or TB.” said Canham.

 

Additional Resources

 

ADA: Return to Work Interim Guidance Toolkit and ADA.org/virus

CDC: Interim Infection Prevention and Control Guidance for Dental Settings During the COVID-19 Response

CDC: Criteria for Return to Work for Healthcare Personnel with Suspected or Confirmed COVID-19 (Interim Guidance)

OSHA: Dentistry Workers and Employers COVID-19 Control and Prevention

 

For more interviews with experts, training resources, and guides, visit Academy.PatientPrism.com.

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