BEST PRACTICES FORRE-OPENING DENTAL CLINICS: EVOLVING & ADAPTINGDentaQuest Partnership & Organization Safety and Asepsis Prevention Webinar July 7, 2020

DOI: 10.35565/DQP.2020.3014

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DentaQuest Partnership Online Learning Center

• Visit our website to access past webinar recordings and earn CE credits upon completion of the online learning modules.

• Sign up for our newsletter to get more information on upcoming webinars.

• https://www.dentaquestpartnership.org/learn/online-learning-center/webinars

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Learning Objectives

By the end of this webinar, participants will be able to:1. Identify resources to ensure your clinic remains current with the evolving

COVID–19 pandemic.2. Discuss measures to reduce the likelihood of the spread of infection as

patient care increases.

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Housekeeping

• All lines will remain muted to avoid background noise.• A copy of the slides and a link to the recording will be shared after the webinar

concludes. • In order to receive CE credit you must fill out the webinar evaluation, which

will be shared at the end of the presentation. The evaluation must be completed by EOD Friday, July 17 to receive CE credit. CE certificates will be distributed a few days after the webinar takes place.

The DentaQuest Partnership is an ADA CERP Recognized Provider. This presentation has been planned and implemented in accordance with the standards of the ADA CERP.

*Full disclosures available upon request

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Q&A Logistics

After the presentations we hope to have some time for Q&AWe will be monitoring the chat box through the entire presentation and we will do our best to answer all questions.• Type your question in the chat box

and make sure you send it to allpanelists.

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Presenters

OSAP – Your Infection Control PartnerVISION• Every dental visit is a safe visit.

MISSION• To be the leading provider of infection prevention and

control, training and credentialing that supports safe dental visits.

COMMUNITY• Clinicians, policy makers, educators, and companies.

Individuals and organizations sharing the vision.

2020 OSAP Annual Conference

www.osap.org/page/2020annualconf

August 13, 14, and 15

Help Us Reinforce a Culture of Safety• Promote patient safety and build patients’ trust in infection control compliance• Support the adoption of the CDC summary and infection control checklist• Champion the role of the infection control coordinator• Build awareness of OSAP as dentistry’s infection prevention partner

Thank You!

BEST PRACTICES FOR INFECTION CONTROL IN DENTAL CLINICSSubtitle: During the COVID-19 PandemicDate: July 7, 2020

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Karen Gregory RN is an employee of Total Medical Compliance.She is a Hu-Friedy Key Opinion Leader, a consultant for SciCan and serves on the OSAP Board of Directors.

Disclaimer

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Committee Members

Editor in Chief: Karen Gregory, RN

Executive Director: Michelle Lee, CPC

DQP Liaison: Julie Frantsve-Hawley, PhD

Subject Matter Experts: Leslie Canham, CDA, RDA, CSP; Karen Daw, MBA, CECM; Nancy Dewhirst, RDH, BS; Jackie Dorst, RDH; Kathy Eklund, RDH, MHP; Marie Fluent, DDS; Linda Harvey, RDH, MS; Michele Lash, RDH; John Molinari, PhD; Joyce Moore, RDH, BSDH, CRCST; Douglas Risk, DDS, ABGD; Katherine Schrubbe, RDH, BS, MEd, PhD; Michelle Strange, MSDH, RDH, Kelli Mack Col USAF 60 MDG (USA),Trish Reynolds, CRDH, BASDH

Copy Editor: Therese Long, MBA, CAE

Prepared by the Organization for Safety, Asepsis and Prevention (OSAP) through an educational grant by the DentaQuest Partnership for Oral Health Advancement (DQP)

This information may change before the end of this session.

Managing Risk.

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CASES Reported to the CDC: January 21 – June 17, 2020

www.cdc.gov/covid-data-tracker/#cases

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Project Goal: Best Practices Resource

Compilation:• Occupational Safety and Health

Administration (OSHA)

• Centers for Disease Control (CDC)

• American Dental Association (ADA)

• American Dental Hygiene Association (ADHA)

PDF fillable ChecklistResources/Tools

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OSHA Risk Designation

• Performing administrative duties in non-public areas of dental facilities, away from other staff members.

Low Risk

• Providing urgent or emergency dental care, not involving aerosol generating procedures (AGP)s to well patients (i.e., to members of the general public who are not known or suspected COVID-19 patients).

• Working in busy staff work areas.

Medium Risk

• Entering a known or suspected COVID-19 patient's care area.• Providing emergency dental care, not involving AGPs, to known or suspected

COVID-19 patients.• Performing AGPs on well patients.

High Risk

• Performing AGPs on known or suspected COVID-19 patients.

• Collecting or handling specimens from known or suspected COVID-19 patients.

Very High Risk

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This best practices resource is designed to help reduce the level of risk from “very

high” through a hierarchy of safety protocols that have

the greatest impact on clinical safety.

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Community Transmission

Asymptomatic and pre-symptomatic transmission• Reduce facility risk• Isolate symptomatic patients ASAP• Protect healthcare personnel• Hospital capacity

Source Control• Patients and visitors wearing masks• Cloth or disposable• Preserve practice supply of PPE

https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html

Local health department directory

State health department directory

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PART 1: Preparing the Dental Clinic Prior to Patient Appointments

• Policies and Procedure

• Dental Team Preparation and Screening

• Equipment and Supplies

• Adjusting Clinical Areas

• Heating, Ventilation, and Air Conditioning (HVAC)

• Entryway and Lobby Area Preparation

• Universal Source Control

• Patient/Visitor Communication and Pre-Appointment Screening

Using the Document: Checklists Part 1

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PART 2: Delivering Safe Patient Care

• Patient Arrival for Appointment

• Dental Operatory Specifics for Patient Care (Targeted to Dentists, Assistants, Hygienists)

• Personal Protective Equipment for the Clinical Team

• Patient Discharge

• Environmental Infection Control

Using the Document: Checklists Part 2

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Using the Document: Practice Tips

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Using the Document: Resources and Tools

Communication is Critical: Patients

Communicate in advance what the practice is doing to ensure the safety of the patient. For example, current with CDC guidelines.• Monitoring local and state recommendations for safety.

• Examples:• When possible come to the appointment by yourself• We may ask you to wait in the car until your appointment time• We will ask screening questions again and your temperature will

be taken as you enter the practice• To protect others in the practice, please wear a mask when you

arrive. • Please use the alcohol handrub as you enter the practice• Contact the practice if COVID – 19 symptoms occur within 48

hours of the visit

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Communication is Critical: DHCP

Communicate in advance what the practice is doing to ensure the safety of worker:• Stay home if you have any COVID – 19 symptoms or other illness.• Screening questions and temperatures will be performed at the

beginning of the workday.• Temperatures taken on non-working days.• Masks should be worn when entering the practice and throughout the

workday.• In between procedures requiring surgical masks/respirators cloth

masks can be worn• Contamination risk, hand hygiene, launder daily• Include eye protection

• Clearly outline the level of PPE the practice will provide.

PROCEED WITH CAUTION

Lobby Area

Remember Social Distancing

Our New Lobby Is

Your Car!!

Please call us or text us to let us know you

have arrived!

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Aerosol-generating procedures (e.g. use of high and low speed handpieces, ultrasonic scalers, air/water syringes and air polishing• If necessary, for emergency care, use four-handed

dentistry, high evacuation suction and dental dams to minimize droplet spatter and aerosols.

• Limit number of DHCP present during the procedure

• N95 respirator or a respirator that offers a higher level of protection

• Collaborate with facility who can provide an Airborne Infection Isolation Room (AIIR)

Aerosol Generating Procedures

https://www.cdc.gov/coronavirus/2019-ncov/hcp/dental-settings.html

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Engineering Controls

• Consult a professional Heating, Ventilation, and Air Conditioning (HVAC) professional regarding options for additional filtration capacity

• For open treatment areas without doors, consider placing dividers of some sort between care area• May consider plastic drape to cover entry into care area• Must be disinfected in-between cases generating aerosols

• Dental dams• High volume evacuation for hygienist and dentists

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Personal Protective Equipment (CDC)

Splashes

• Gloves• Eye protection• Gown (protective

clothing)• Surgical mask

Aerosol Generating Procedure

• Gloves• Eye protection• Gown (protective

clothing)• N95 or higher

Suspect or Confirmed

COVID - 19

• Gloves• Eye protection• Gown (protective

clothing)• N95 or higher

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Personal Protective Equipment Designate an area outside of the operatory for

donning/doffing of PPE

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N95 Respirator Healthcare

• Class II medical device• NIOSH approved• Tight seal over the mouth and nose• Fit-testing required• Fluid resistant• OSHA Respiratory Protection Standard, 29CFR 1910.134

FDA.gov

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Respiratory Protection Standard

• 29 CFR 1910.134

• Written Respiratory Protection Program (RPP)

• Applies:

• Exposed to a hazardous level of an airborne contaminant; or

• Implemented the use of an N95 respirator or higher

• Medical evaluation

• Fit testing

• Training

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Fit Testing

This memorandum expands temporary enforcement guidance provided in OSHA’s March 14, 2020, memorandum to Compliance Safety and Health

Officers for enforcing annual fit-testing requirements of the Respiratory Protection standard, 29 CFR § 1910.134(f)(2), with regard to supply shortages of N95s or other filtering facepiece respirators (FFRs) due to the coronavirus

disease 2019 (COVID-19) pandemic. OSHA field offices will exercise enforcement discretion concerning the annual fit-testing requirements, as long as employers have made good-faith efforts to comply with the requirements of

the Respiratory Protection standard and to follow the steps outlined in the March 14, 2020 memorandum.

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Medical Evaluation

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FDA Website lists acceptable respirators from China.

Counterfeit Respirators

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Surgical Masks

• FDA reviews and clears; class II medical device.• Different thicknesses and ability to protect from contact with liquids. • Block large-particle droplets, splashes, sprays, or splatter.

• Protect the environment from the wearer• Reduce exposure of the worker’s secretions.• Do not provide complete protection because of the loose fit.• ASTM Level 2 or 3 will provide the highest level of respiratory protection.

FDA: https://www.fda.gov/medical-devices/personal-protective-equipment-infection-control/n95-respirators-and-surgical-masks-face-masks#s2

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Aware of PPE inventory and supply chain.Aware of PPE utilization rate.Aware of status of community spread.Facilities have already implemented other engineering and administrative control measures including:

• Reduction in number of patients seen• Reducing face-to-face HCP encounters

with patients• Maximizing use of telemedicine

Training for any changes to normal processes.

Optimize PPE Supply

https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/index.htmll

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• Disinfect surfaces with EPA registered hospital level disinfectant

• EPA list of products

After Patient Discharge

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Worker Exposure?

48 hours afterappointment

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• Contact the Health Department for direction on how to proceed.• Identify close contacts – other workers/patients.

• Critical to have documentation of employee screening daily.• Masks and eye protection should be worn when near workers/patients

who do not have on mask.

Worker Tests Positive?

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EvolvingDevelop gradually, especially from a simple to a more complex form.

Definition from Oxford Languages. Photo courtesy of CDC.

https://www.dentaquestpartnership.org/osap-best-practices

https://cdn.ymaws.com/www.osap.org/resource/resmgr/dentaquest/INC-1353_Best_Practices_for_.pdf

QUESTIONS?

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Webinar Evaluation https://www.dentaquestpartnership.org/node/208024*Must complete by EOD Friday, July 17 in order to receive CE credit

Upcoming Webinars:• Barriers to Dental Access for Special Needs Patients (July 16 at 1:00 PM –

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