Important News For You to Know

Coronavirus Disease (COVID-19) Management

for Dental Professionals

 

March 11, 2020

As of now, the best protection against the Coronavirus Disease (COVID-19) for dental professionals is a heightened sense of awareness, avoiding unnecessary contact with patients that may have COVID-19, use of appropriate personal protective equipment, and increased attention to office cleanliness and personal hygiene. This communication addresses information and issues affecting dental professionals in relation to COVID-19.

 

As relevant new information is obtained, we may update this Memo for redistribution.

 

General Information

 

What it is:

  • COVID-19 is a respiratory illness that can spread from person to person.

  • Risk of infection with COVID-19 is higher for people who are in close contact with someone known to have COVID-19, for example, healthcare workers or household members.

  • Other people at higher risk for infection are those who live in or have recently been in an area with ongoing spread of COVID-19.

  • The majority of fatalities have been in elderly patients with compromised immune systems, as a result of comorbid conditions like diabetes, coronary artery disease, pneumonia, COPD, etc.

  • However, young and healthy people have also died from the disease, which causes even more heightened fear in the healthcare communities.

 

Symptoms:

  • Patients with COVID-19 have had mild to severe respiratory illness with symptoms of:

    • Fever

    • Cough

    • Shortness of breath

  • In 80% of the cases, especially in young, healthy patients, symptoms have been mild, similar to that of a cold or flu.

  • In 15% of the cases, patients have had progressive respiratory symptoms which have caused hospitalization.

  • In 5% of the cases, patients are critically ill and require intensive care unit support.

  • The overall fatality is estimated to be about 2%, so far.

 

 

How it is transmitted:

 

The virus is spread mainly from person-to-person:

  • Between people who are in close contact with one another (within about 6 feet).

  • Through respiratory droplets produced when an infected person coughs or sneezes.

 

These droplets can land in the mouths or noses of people who are nearby, or possibly be inhaled into the lungs.

 

  • People are thought to be most contagious when they are most symptomatic (the sickest).

  • There have been reports of the spread of the virus before a person showed symptoms, but this is not thought to be the main way the virus spreads.

 

It is possible that a person may get the virus by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes, but this is not thought to be the main way the virus spreads at this time.

 

What if there are NO symptoms?:

 

In many cases, the first symptom has been a fever, but since this is so new (and spreading) we don’t fully understand all of the properties this virus has. So we must be concerned that exposure to those with the virus is a risk. There is a possibility that a healthy individual, or someone with cold symptoms, may be carrying and transmitting the virus unknowingly. So we must be concerned about people traveling in areas which are known sites of infection.

 

Dental Staff Management

 

How we protect ourselves:

 

As dental professionals, we protect ourselves every day from infectious particles. Since this infection is so new, we do not have vaccines to build our immunity against the harm of this virus. To protect ourselves, please pay close attention to the following:

  • Management of the waiting room

  • Clear patient communication on use of patient risk reporting, tissues, sanitizer, and covering a cough or sneeze

  • Hand hygiene

  • Use of PPE, including gloves, gowns, face masks, eye protection (and use of care when taking off and disposing of PPE)

  • Following sterilization procedures

  • Staff communications and updated information

Remember Your Infection Control Practices

Good hand hygiene is the most important protection for the dentist and the staff:

  • Thorough hand washing with soap and water

 

  • Lather hands with soap

  • Lather the back of hands, between the fingers and under the nails

  • Scrub hands for at least 20 seconds

  • Rinse off

  • Dry hands with a clean disposable towel or air dry them

 

Pay closer attention to:

  • Sharps safety

  • Injection safety

  • Waste disposal

  • Sterilization of instruments and devices

  • Disposal of PPE

Personal Protective Equipment

Because the coronavirus is mostly an airborne virus, conventional surgical masks may not be adequate to protect against someone who is clearly infected.  Use your conventional surgical masks for normal precaution, but if you suspect someone of the virus or if someone exhibits flu-like symptoms, please use the N95 Mask/Respirator to address (or treat) the patient, if and when available.

 

Be vigilant in constant and proper use of PPE:

 

  • Face mask and shield protection

  • Goggles or eye mask

  • Gown

  • Gloves

 

Be careful not to touch your face when taking off PPE.

 

Employees who may be infected:

  • The company will be sending frequent alerts to the offices, with information we receive from state and federal governmental web sites.

  • If you or a co-worker are or suspected infected with the virus, you/they should immediately call the hotline and self-quarantine (at home). We realize that not everyone’s circumstance is the same, so management staff will be in touch with you to go over considerations.

  • If an employee shows symptoms of flu or fever, we will send him/her home immediately and require the employee to be tested and cleared by a medical doctor before he/she can return to work.

Patient Management

Appointment Reminder Call Assessment:

When performing calls for appointment reminders, tell patients that because of the coronavirus, we need to assess the risk for all of our patients.  Ask each patient if:

  • They are sick with (or have symptoms of) fever, cough, sore throat, muscle pain, and/or GI symptoms

  • They have had foreign travels within the past 30 days. The list of concerned travel areas will change frequently, but as of 3/9/2020, the CDC level 3 and level 2 COVID-19 travel advisory areas include:

    • China (not including Hong Kong, Macau or the island of Taiwan)

    • South Korea

    • Italy

    • Iran

    • Japan

  • This would include the airport or a flight connection

 

Updated CDC Travel Health Notices may be found at:  https://wwwnc.cdc.gov/travel/notices

If a patient is deemed to be at risk after the above screening, the patient should be re-scheduled for non-emergent dental treatment at a time no less than 14 days later, but preferably 30 days later.  Each rescheduled patient should be screened again just prior to the rescheduled appointment date.

 

Emergency patients (patients expressing pain or infection symptoms) should be scheduled for treatment in accordance with normal emergency visit scheduling procedures.  However, such patients should be asked to adhere to safety precautions to avoid infecting others, such as, for example, wearing a face mask and being reminded of handwashing and coughing/sneezing hygiene.  Upon check-in, the patient should be provided with a mask, depending upon availability, and escorted to a designated, private treatment room immediately.

 

Waiting Room/Reception Management:

 

  • Each office should have a prominent sign directing the patient to use a hand sanitizer from a non-touch dispenser stand and to rigorously rub their hands for 20 seconds.

  • Front desk staff should stay at least 6 feet away from symptomatic patients, when at all possible.

  • Remove any magazines and toys from waiting rooms.

  • Wipe down waiting room chairs, furniture, counter tops, door knobs, etc. with a disinfectant as frequently as possible.

  • Wipe down the front desk area and bathrooms with a disinfectant as frequently as possible.

  • Open the doors frequently to air out the office. Be certain, however, that if the back door is opened, that it not be left unattended for a stranger to walk in.  We don’t want surprises.

 

Patient Management

Each patient should be given a questionnaire and queried about current illness and symptoms.

  • The questionnaire should also inquire about travel to endemic areas within the past 30 days, including the airport(s) or a flight connection.

  • Any patient demonstrating symptoms of fever, cough, sore throat, muscle pain, and/or GI symptoms should:

Be given our Allied Alert Memo on the Coronavirus

Be given a mask, if supplies are sufficient enough to do so

Be asked to seek medical help

Be rescheduled for a time no less than 14 days later, but preferably 30 days later, unless the patient is presenting for an emergency dental condition (see above regarding emergency patients).

  • Symptomatic patients who must be seen should be escorted to a designated, private treatment room and dental treatment should be commenced as expeditiously as possible.  When possible, non-emergent treatment should be rescheduled to a later date.

 

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This document can be downloaded to print here >

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New Update - Emergency Preparedness