Re-emergence Pediatric Dentistry PRACTICE CHECKLIST · 2020. 5. 13. · Re-emergence Pediatric...
Transcript of Re-emergence Pediatric Dentistry PRACTICE CHECKLIST · 2020. 5. 13. · Re-emergence Pediatric...
Re-emergence Pediatric Dentistry PRACTICE CHECKLIST 1
Re-emergence Pediatric Dentistry
PRACTICE CHECKLIST
A guide for re-entry into practice for pediatric dentists during the
COVID-19 pandemic
Updated 4/28/2020
2 Re-emergence Pediatric Dentistry PRACTICE CHECKLIST
TABLE OF CONTENTS
PRE-EMERGENCE PROCESSES4 Supplychainverification4 General 4 Employeecalibrationprocesses5 Teledentistry5 Staffandemploymentconsiderations5 Testingandresearch5 Physicalspace/officemodifications6 Pre-closure/closurepatientstatus
PRACTICE RAMP UP SCHEDULE CONSIDERATIONS7 Addressingfamilyunitbehavior7 Gettingreadytostartupagain
SITUATIONS UNIQUE TO THE SPECIALTY OF PEDIATRIC DENTISTRY8 Childrenrequiringbehaviorguidance(BG)withenhancedphysical contact8 Childrenwithcompromisedimmuneillnessorwithcomplex medicalcareneeds8 Immediatecareforhighcariesindexpatients/emergencies9 Patientsfromgrouplivingsites9 Traumaticinjury9 In-officeanesthesiatreatment9 Hospitaldentalcases
POINT-OF-CARE CONSIDERATIONS/OPERATORY ENVIRONMENT10 Ventilation10 Useof highcapacityevacuationdevices10 PPEandinfectioncontrolenhancement11 Viralnumbersandaerosols11 UVC 11 HEPA 11 SingleUseEquipment11 Nitrousoxidesterilization11 Miscellaneous
PRACTICE MANAGEMENT CONSIDERATIONS13 If anownerof apractice13 If youareassociatedwithlocalhospitals13 Insuranceandpayerconsiderations14 Medicaidandpublicconsiderations14 If youareanassociateoremployeedentist14 Forpendinggradsandnewgrads14 Thirdpartycomplianceoversight
PREFACE
DearColleagues,
ThetremendouschallengeswearefacingduetotheCOVID-19crisisareunprecedentedinmostof ourlifetimes.Ourhealthcaresystem,oureconomy,andournation’speoplewerenotreadyfortheimpactof thisvirus.Andweandourpracticeswerenotpre-paredforthefar-reachingeffectsof thepandemicandonlynowarebeginningtolookatre-emergencefromclosuresandemer-gency-onlyoperationtogetbacktocaringforchildren.
Re-emergencefromthedepthsof thepandemicwilltaketimeanddefininga“newnormal”forourlivesandourpractices.Nooneisreallysureof whattheendof thispandemicwilllooklike,sowecanonlytrytodoourbesttocraftasafeandeffectivepracticeenvironment.Further,becauseof thenoveltyof thiscrisis,howweapproachrenewalof ourpracticeswillbeamixof applicationof existingscience,interpretationof newfindings,andcreativityandcommonsense.Untilmoreisknownabouttransmission,testing,andimmunity,aswellastheeffectivenessof mitigationefforts,theserecommendationsare,atbest,merelyguideposts,notadefinitiveroadmap.
Becauseof uncertaintiesandtheevolvingunderstandingof thevirus,wefeltitwouldbelessvaluable,andinfact,counterpro-ductivetobeprescriptivethantodirectmembersindirectionsthatseemimportanttoconsiderintheresumptionof practice.Becauseof competinginformationandsignificantdifferencesinstates’approachestoreestablishingtheireconomieswhilestillcontrollingthevirus,wefeltitbesttodirectpediatricdentiststolooktoreliablelocalandnationalsourcesof informationtogetspecificinformationinthecategoriesinthischecklist.
Thechecklistoffersdocumentsandlinksthatwereavailableatthetimeof itsconception,butthosecanchangeandsomeal-readyhave,butareincludedbecauseof theirhistoricalreference.
Wehopethatthisdocumentprovesusefulasstatesopenuprestrictionsandweallbegintogetbacktocaringforchildreninwaysthataresafeforthem,theirfamilies,ourstaffandourselves.
Sincerely,
The Safety Committee
Casamassimo, P., Castellano, J., Conte, C., Czerepak, C., Jacobson, B., Lee, J., Miller, J., Younger, L.
Re-emergence Pediatric Dentistry PRACTICE CHECKLIST 3
INTRODUCTION Thischecklistismeanttobeaguideforre-entryintopracticeforpediatricdentists.
Thechecklistisbasedonbestinformationatthetimeof itscreation.Theevolvingnatureof theCOVID-19pandemic,scientificdiscoveriesrelatedtovirustransmission,anddataoneffectivemitigationeffortsandtreatmentsmakeanysetof recommendationsandareasof con-siderationtime-sensitive.Usersof thisguideshouldcontinuetoconsultwithreliablenationalandlocalsourcesregularlyandadheretorecommendeddirectivesthatapplytotheirlocusof practice.
Inaddition,sourcesof informationprovidedintheresourcesectionof thisdocumentmaybecomeoutdatedwithnewinformationovertime.Adherencetorecommendationsbygovern-mentandprofessionalorganizationsshouldbebasedonmostcurrentversionsof advice.
Forthelongerterm,untilimmunityagainstCOVID-19isachieved,ouractionsaspediatricdentistsshouldbealignedtoachievethefollowing:
1. EnsuretheU.S.healthcareworkforcehasabilitytocareforthesickwithinourhospitals,
2. Preventinfectionwiththeviruspersonallyandprofessionally,
3. Buildcapacitytoprotectthehealthandwell-beingof thepublicandpediatricdentalworkforce,
4. Reducesocial,emotionalandeconomicdisruption,
5. Optimizeoralhealthof childrenwecarefor.
Becauseof impactsonhealthcare,povertyandeconomy,thecurrentpracticestateof onlyemergencydentalcarethatmanystatesandprofessionalorganizationshaverecommendedorrequiredinattemptstomitigatethespreadof COVID-19isunsustainableinthelongterm.Thus,thischecklistisdesignedtoaddresssignificantareasof practicethatmayneedattentionpriortoresumptionof pre-pandemiclevelsof care.Italsotakesintoconsiderationnewandpossiblechangesasaresultof thepandemicanditslingeringeffectsandretrospectiveactionstoreturnpracticestooptimalfunction.
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PRE-EMERGENCE PROCESS
Inordertobegintogetbacktopatientcare,anumberof stepsshouldbetakentoprepareafacilityforre-openingandstafftobeabletofunctioninthe“newnormal”environment.Thisfirstsectionreflectsguidelinesaswellasmember-drivenideastofacilitatetherestartof apractice,aimedmainlyatpersonnelpreparationandphysicalchanges.ThesuggestionsofferedhereareaimedatsafetyaswellasoperationalchangesconsistentwithwhatisknownandstillemergingabouttheCOVID-19pandemic.
Supply chain verification:
• PPEguidelinesastheyapply
• Newdisposablerecommendations(egN2O)
• Stayinconstantcontactwithdentalsupplyrepsforavailabilityof PPE
• Bewaryof graymarketPPE
TOPICS AND CONSIDERATIONS RESOURCESResourcesaremeantforbackgrounduseandarenotinchronologicalorder.Usersareadvisedtoverifyaccuracy.
• AmericanDentalAccessories
• AMSystems:RespiratoryandAnesthesiaEquipment:ViroMaxViralandBacterialFilter
• TheADA’sAdvisoryTaskForceforDentalPracticeRe-coveryhasdevelopedafreetoolkitformembersofferinginterimguidanceonmeasurestohelpprotectpatients,staffanddentistsfromCOVID-19asdentalpracticesre-engageinprovidingthefullrangeof oralhealthcare.Toreceiveacopy,visitthisADAsiteandfillouttheformforalinktothetoolkit.
• ADAInterimGuidanceandMinimizingRiskCompre-hensiveResource
• ADAGuidetoUnderstandingandDocumentingTeledentistryEvents
• ADA:WhatConstitutesaDentalEmergency
• ADAWebinar:COVID-19:WhatToDoIf aPatientorDentalStaffTestsPositive
• ADA:WhattoDoif SomeoneonYourStaffTestsPosi-tiveforCOVID-19
• ADA COVID-19CodingandBillingInterimGuidance
• CDCCOVID-19GuidanceforHealthcare Professionals
• CDC:InterimInfectionPreventionandControlGuidanceforDentalSettingsDuringtheCOVID-19Response
• CDCPoster:PPETrainingforStaff
• CDC UsingPPEWhenCaringforPeoplewithCon-firmedorSuspectedCOVID-19
• DoxyTelemedicineTool
General:
• Reviewcurrentinfectioncontrolpractices
• Pediatricriskislow
Employee calibration on processes:
• Considerdevelopingarespiratoryprotectionprogram:
1. Youmusthaveaprogramadministratorthatisqual-ifiedbyappropriatetrainingorexperience(DDSalonedoesnotqualify)
2. RespiratoryProtectionProgramElements: a. Selection b. Medevaluation c. Fittesting d. Use e. Maintenanceandcare f. Breathingairqualityanduse g. Training h. ProgramEvaluation
• Patienttriagefororalhealthneed
• Developascriptforfrontofficescreeningof patientsforbothdaybeforeanddayof appointment
• Assessment of COVID-19 risk
• Referraloptionsidentifiedforpatientswhohaveaposi-tiveCOVID-19testresults
Re-emergence Pediatric Dentistry PRACTICE CHECKLIST 5
• EPA:DisinfectantsforUseAgainstSARS-CoV-2
• HowtoChooseandUseEnvironmentalSurface Disinfectants
• MMWRHospitalizationRatesandCharacteristicsof PatientsHospitalizedwithLaboratory-ConfirmedCoronavirusDisease2019
• SocialDistancingProtocolfromSanMateo County,CA
• StandardandTransmission-BasedPrecautionsin Dentistry
• Sampling:Adult
• Sampling:Pediatric
• Test:LoopMediated
• Test:RT-PCR
Hospitalization Rates and Characteristics of Patients Hospitalized with Laboratory-Confirmed Coronavirus Disease 2019, COVID-NET, 14 states March,4-30, 2020, MMWR April 8, 2020
Pediatric COVID –19 Imaging
Reference: Lu et al, Letter to the Editor, March 18, 2020 NEJM, Xia et al Pediatric Pulmonology, 2020:1-6
If you use teledentistry:
• Describethetriageprocess
• Describetheexpansion/reductionof theuseof teledentistry,if implementedduringcrisis
Staff and employment considerations:
• Untiltesting,considerriskreductionmeasures:takingtemperatures
• Non-contactrolesforstaff
• Managinglaundry
• Abtiterswhenutilityisestablishedonlimitinginfection
• Considervaccinerequirementwhenavailable
• Whattodoif someoneonstafftestspositiveforCOVID-19
• Protocolfor“non-returntowork”employees
• Checkinregularlyonstaffstatusandmorale
Testing (when available), some types to research are:
• Reversetranscriptionpolymerasechainreaction(RT-PCR)test
• Loop-mediatedisothermalamplification(lamp)
• Sampling:adultandchild
• Knowthedifferencebetweenantibodyvsvirustestsand accuracy
Physical space/office modification:
• Usecommontermsusedbygovernment,publichealthdepartments,andCDC(socialdistancing)
• Considerbarriersinbay
• Considerhavingdrapesinstalledbetweenchairs
• Removehard-to-disinfectitemsfromoperatoriesandwaitingrooms(toys,decorations,books,magazines)
• Createcleaningscheduleforefficiency
• Considernewsignageinofficetopreventpatientsfromwalkingthroughthewrongareas.
• Planwaitingarealayoutforsocialdistancingwhilemaximizingexperienceduringreception
• Considerleavingfrontdoortoofficeopenorinstallationof electronicdooropeners
• Considerwhatasafenumberof peopleisandif therearedistancesthatneedtobemaintainedwhilethepatientswaitforappointment
• Isthereaneedtoplaceairpurifiersinthesehighvol-ume/trafficareas?
TOPICS AND CONSIDERATIONS RESOURCESResourcesaremeantforbackgrounduseandarenotinchronologicalorder.Usersareadvisedtoverifyaccuracy.
ForCOVID-19
resourcesfromthe
AAPD,visitthe
AAPDCOVID-19
UpdateCenterat
aapd.org.
6 Re-emergence Pediatric Dentistry PRACTICE CHECKLIST
• Contactarchitectorheatingconstructiontodeterminerateof airturnoverinoperatoriesand/oropenbays
• Aerosolevacuationunits(notadvisedatthistime,butfollowscientificadviceasitchanges)
• If possible,closedoortotreatmentroomduringtherapy
• Considerreducingtheamountof potentialinfectiouscontactpointsandpatientinteractiontouchpoints.Forexamplewipingdownof pensandcreditcardprocess-ingmachines(orprocessors),lessenpenandformtrans-ferswithcontactlesssolutionsorself-servicesolutions(forms,records,etc)
• Identifyprocedure-specificoperatory/rooms/spaces/andattempttolimitlengthof appointments
• ConsidertreatingCOVID-19positivepatientsattheendof theday
• ConsiderhavingaCOVID-19assignedteamforposi-tivepatients
• Receptionstaffprotection/barriers/PPE
• Inopenreceptiondeskconsiderplacingtemporaryacrylicbarrierstoprotectreceptionist
• Negativepressurerooms(notadvisedatthistime)
Pre-closure/closure patient status:
• Followuponemergencypatientsseen:describebacklogof urgentoremergentcasesneededtotreatandthechangesinseverityof thecasesandwherepatientswentforcare
• FollowuponpendingsedationandGAcases
• Stagingof missedrecall/newpatients
• Websiteupdates
• Officecompliancenoticesforpatients(howtheofficeiscomplyingwithfederal,state,localmandatesandguid-anceinregardtodentalpracticeandCOVID-19)
• Phonemessagingupdates
• Giveadequatetimetoreviewcoverageandact
TOPICS AND CONSIDERATIONS
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PRACTICE RAMP UP SCHEDULE CONSIDERATIONS
Restartingpracticeshashumanelementsaswellasphysicalconsiderations.Thelevelof patientconcernaboutrenewingdentalcareisunknownandapartof theprocessistheneedforpatientassuranceandmakingsurethatstaffareabletocommunicatewithfamiliesaboutstepstakenandshowothermeasurestoassuretheirsafety.
TOPICS AND CONSIDERATIONS RESOURCESResourcesaremeantforbackgrounduseandarenotinchronologicalorder.Usersareadvisedtoverifyaccuracy.Addressing family unit behavior:
• Lookatspacingandotherinfectioncontrolmeasures(barriers,staggeringappointments,carwaiting,useof pre-screeningviaphone,oneguardian,nosiblings,no-touchsignin,notoys/books/magazines)
• Balanceexposureriskandpatientseparationwithsim-ple,cost-effectivepatientflowpoliciesandprocedures
• Maximizetreatmentandaccessandincorporateacutepandemicperioddisplaced/rescheduledpatients
• PPEsustainablestrategies:considermasksandsanitiz-ersatdoorforfamilies
• DuetoPPEshortageconsiderrequiringpatientstoar-riveatofficewitha“facecover”andprovidemaskonlyif/whennecessary
• Inadditiontocurrentadviceonfeverandsymptomscreening,evaluateanddevelopadditionalscreeningproceduresthatwillimproveidentifyingpatientswithinfection,whoareasymptomatic,includingchildren
• ADA:COVID-19FrequentlyAskedQuestions
• ADA:OSHAGuidanceSummaryforPreparingWork-placesforCOVID-19
• ADAScreeningandRiskMitigationAlgorithms
• ADAStateDentalMandatesandRecommendations
• AmericanDentalAccessoriesDentalPracticeAdvice
• CDC:InterimGuidanceforBusinessesandEmployers
• Clinician’sReportfromGordonChristiensen
• CoronavirusBlog:DropletvsAirborneTransmissionWarning
• CoronavirusDisease2019(COVID-19):EmergingandFutureChallengesforDentalandOralMedicine
• Dimensionsof DentalHygiene:ProtectingYourself
• FDA:SurgicalMaskandGownConservationStrategies-LettertoHealthcareProviders
• FederalGuidance:OpeningUpAmericaAgainGetting ready to start up again:
• Utilizereal-timeCOVID-19diseaseprogressionre-sourcesthatgivestate/countydatatobestunderstandyourcommunity’sdiseasestatus
• UtilizeResourcesforIndustryReopeningGuidance
• Knowindividualstatemandatesrelatedtopracticeof dentistryduringCOVID-19
• Understandthedifferencebetweendropletandaerosolcontamination
• Understandingdentalaerosolsandsplatterandmitiga-tionapproaches
• Developastart-upplanforyouroffice
• Createapost-crisisSOPManualorrevisecurrentofficemanual
• JADA:AerosolsandSplatterinDentistry
• JohnsHopkinsCOVID-19U.S.CasesbyCounty
• JohnHopkins:PublicHealthPrinciplesforaPhasedReopeningDuringCOVID-19:GuidanceforGover-nors
• N-95RespiratorsandSurgicalMasks,FDA
• NIOSH:Slideshow,AerosolGenerationandBehavior
• Return-to-practiceroadmapfordentistsinpost-COVID-19pandemic
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SITUATIONS UNIQUE TO THE SPECIALTY OF PEDIATRIC DENTISTRY
Theuniquepatientmixof pediatricdentalpracticechallengesustoprepareforsituationsthatmaynotoccurforgeneraldentalpracticesorotherspecialties.Thissectioncoversdifferentpatientgroupsweaspediatricden-tistsseeregularlyandstepsthatcanbeconsideredtomaketheirtreatmentsafeandeffective.
TOPICS AND CONSIDERATIONS RESOURCESResourcesaremeantforbackgrounduseandarenotinchronologicalorder.Usersareadvisedtoverifyaccuracy.Children requiring behavior guidance (BG) with
enhanced physical contact and multiple personnel:
• DelayphysicalBGpatients
• Considertreatingpatientwhileonparent’slapwithpar-entwearingmaskandhavingpassednegativescreeningcriteria
• Specialhours
• Prepareforpossiblereferralspriortocontamination
• Scrubchangefrequencyandlaundering
• Restraintdevicecleaning
• EnhancedPPEuseif recommendedwithPPEgearedtospecificroles/likelihoodof exposure
Children with compromised immune illness or with complex medical care needs:
• Considerpreparingprotocolsandreferralsources
• HaveMDandhospitalprotocolsonhand
• ConsultwithMDaboutsafetyof childbeingseenatclinic
• AAAASF’sguidetore-openingyourAAAASF-accredit-edfacilityafterclosureduetoCOVID-19
• AmericanCollegeof Surgeons:LocalResumptionof ElectiveSurgeryGuidance
• AAPD:Managementof DentalPatientswithSpecialHealthCareNeeds AmericanCollegeof Surgeons:ClinicalIssuesandGuidance_COVID-19
• AmericanCollegeof Surgeons:LocalResumptionof ElectiveSurgeryGuidance
• ASDAInterimGuidanceForDentistAnesthesiologistsPracticingInTheOffice-BasedSettingDuringTheCOVID-19Pandemic
• ASHRAE:NewVentilationGuidelines
• CariesManagementStrategiesforPrimaryMolars
• CDC:CaringforChildren_COVID-19
• Effectof sensoryadaptationonanxietyof childrenwithdevelopmentaldisabilities:anewapproach.• Considerhospitalbaseddentalclinicsif available
• Considerthetimingof theappointmentintheschedule(1stappointmentsorspecialhours/days)
• Considerbuildingaroomthatmeetshospitalstandardsforinfectioncontrolandairturnover
Immediate care for high caries index patients/ emergencies:
• Maximizingtreatmentpervisittoreducenumbersof visits
• Establishprotocolsforpainandreferrals
• Developariskbasedscaleforschedulinggeneral anesthesiapatients
Re-emergence Pediatric Dentistry PRACTICE CHECKLIST 9
TOPICS AND CONSIDERATIONS RESOURCESResourcesaremeantforbackgrounduseandarenotinchronologicalorder.Usersareadvisedtoverifyaccuracy.• Determinewhenthehospital/surgicalcenterwillbe
schedulingelectivedentalpatients
• Developstrategiestotemporizecariousteeth:useof IRM,glassionomer
Patients from group living sites:
• Considerpre-screeningforsymptoms
• Teledentistrytriage
• Specialhourstomaximizeaccessandtreatment/reduceexposurelikelihood
• Developacommunicationlinkwiththeproviderre-sponsibleforthehealthof thepatient
Traumatic injury:
• Considerdedicatedafter-hoursroom
• Pre-screeningforsymptoms
• Consideringageof patients,toothstatus,occlusionandmedicalandviralstatusof patient
• Teledentistrytriage
• After-hoursteamhazardpay
• Knowwhatcanwait
• GuidanceonPreparingWorkplacesforCOVID-19
• PlanningAdvice:Designdistinctionsforexam, procedureandoperatingrooms
• RoadmapforResumingElectiveSurgeryAfterCOVID-19Pandemic,JointStatement
• StrategiesforOptimizingtheSupplyof IsolationGowns
In-office anesthesia treatment:
• ConsiderPPErequirementsforadditionalstaff
• Implementdisinfectionprotocolforequipment
• Considerschedulingtoreducetransmissionlikelihood
• RefertoASDArecommendations
• Considerdisposablevsclothgarmentsforstaffinanes-thesiapatients
Hospital Dental Cases:
• Morestringentpre-andintra-operativestepsforhospi-talcases
• Considerreferraloptionsandpre-optimeframe
• Complywithscreeningandmanagementprotocolsoutsideof theoffice
• BefamiliarwithDepartmentof SurgeryGuidelinesforelectivecases
• Determineif thehospitalsystemwillallowdentiststousesatellitecenters
• ConsiderreviewingoptionsforORandspecialtyrefer-ralsources
• Complywithincreasedscreeningandmanagementprototcolsoutsideof theoffice
10 Re-emergence Pediatric Dentistry PRACTICE CHECKLIST
POINT-OF-CARE CONSIDERATIONS/ OPERATORY ENVIRONMENT
Muchof thefocusof areturntodentalpracticehasbeenoninfectioncontrol,andmuchof thatrelatedtothedentist-patientinterface.Todate,nostudiesconfirmthebenefitsof additionalprecautionsontransmission.Theideasandresourcespresentedinthissectionarereiterationof provenandtrustedapproaches,thebestguessesof experts,andsomecommonsenserecommendationsof dentistswhoarefamiliarwiththetreatmenttriadandtheuniqueaspectsof deliveryof careinapediatricdentalpractice.Theresourcesofferedaretime-limitedsousersshouldattendtodatesandrelayonmorecurrentinformationasitbecomesavailable.
TOPICS AND CONSIDERATIONS RESOURCESResourcesaremeantforbackgrounduseandarenotinchronologicalorder.Usersareadvisedtoverifyaccuracy.Ventilation:
• Considerpartneringwithlocalhospitalorsurgerycen-terbasedonavailability
• Considertheuseof disposable/sterilizablenitroustubing
• Determinewhichdentalprocedurescanbeaccom-plishedwithoutcreatinganaerosolanddesignatetheseas“dryappointments”allotherappointmentswouldbeconsidered“wet”andhigherrisk
• ConsiderwearingaregulardentalmaskoveryourN95maskstopreservetheN95masks
• Considerthatairexchanges,filteringandexhaustfanscanimproveflow,socheckwithcontractor/buildingmanager
• ADACOVID-19WebinarsonTransmissionand Emergency
• ADA:InterimMaskandFaceShieldGuidelines
• ADA:UnderstandingMasks
• ADSExtraoralDentalSuctionSystem
• ASHRAEStandard:VentilationforAcceptableIndoorAirQuality
• BentleyCD,BurkhartNW,CrawfordJJ.Evaluatingspatterandaerosolcontaminationduringdentalproce-dures.JAmDentAssoc.1994;12:579-584.
• CaliforniaCodeof Regulations:IndoorAirQuality
• CDC:BloodbornePathogensandAerosolsinDentistry
• CALOSHA:CaliforniaWorkplaceGuidetoAerosolTransmissibleDiseases
• CDC:DecontaminationandReuseof FilteringFacepieceRespirators
• CDC:GuidelinesforEnvironmentalInfectionControlinHealth-CareFacilities(2003)pg.1
• CDC GuidelinesforEnvironmentalInfectionControlinHealth-CareFacilities(2003)Pg.2
• CDC:StrategizingforOptimizationtheSupplyof IsolationGowns
• CDC:SterilizingPractices
• Comparisonof suctiondevicewithsalivaejectorforaerosolandspatterreductionduringultrasonicscaling
• Considerhavingschedulingseparateaerosolproceduredaysandnon-aerosolproceduredaystoallowcleaning/disinfectiontimeforaerosolproducingprocedures
Use of high capacity evacuation devices:
• Considermultiplesuctionunits
• Referralstohospitalorsurgerycenterasneeded
PPE and infection control enhancement:
• ConsidercleaninganddisinfectionprotocolstoadjustforCOVID-19
• Followrecommendedchangesinpoint-of-contactpa-tientcarefromreliablesources
• Considerscreeninglogsandtemperaturetakingforstaffandadultsaccompanyingpatients(benefitnotprovenatthistime)
• Reuseof N-95masksif necessary
Re-emergence Pediatric Dentistry PRACTICE CHECKLIST 11
TOPICS AND CONSIDERATIONS RESOURCESResourcesaremeantforbackgrounduseandarenotinchronologicalorder.Usersareadvisedtoverifyaccuracy.
• ConsumerHealthReports:WhattoknowaboutAirPurifiersandtheCoronavirus
• ConsumerLab:UltravioletLightSanitizersand Coronavirus
• COVID-19EvidenceService|AddressingCOVID-19FaceMaskShortages[v1.1]
• CPAC:RHN95DecontaminationSystem
• Crosstex:InstructionsforUseof AxessRFSNasalMaskSystem
• Crosstex:Reprocessingof ScavengingCircuitsandMulti-UseNasalMasks
• Crosstex:TheRightMaskfortheRightTask
• ECRI:Safetyof ExtendedUseandReuseof N95Respirators
• Efficacyof preproceduralmouthrinsesinthereductionof microorganismsinaerosol:Asystematicreview
• FDA,N-95RespiratorsandSurgicalMasks
• HowtoProperlyPutonandRemoveaDisposableRespirator
• IMC:Canmasksbesterilizedwhileretainingprotectivefunction
• Theefficacyof therubberdamasabarriertothespreadof microorganismsduringdentaltreatment
• JacksM.Alaboratorycomparisonof evacuation devicesonaerosolreduction.JDentHyg. 2002;76:202-206.
• MinnesotaDeptof HealthOfficeof Emergency Preparedness:AirbornInfectiousDisease Management_MethodsforTemporaryNegative PressureIsolation
• NAFA:TalkingAirFiltration
• NAFA:TalkingAirFiltrationwithDr.JeffSiegel Universityof Toronto:COVID-19FAQsandAir
• NAFA:COVID-19andAirFiltrationFrequently AskedQuestions
• NIOSH:UnderstandingtheDifferenceBetween MaskandRespirator
• OSHAGuidanceonPreparingWorkplacesforCOVID-19
• OSHA:FitTestingProceduresforRespirators
• OSHA:HealthandSafetyTopics_IndoorAirQuality
• OSHA:HowtoPerformaUserSealCheckwithanN95Respirator
• Continuetotestanddocumenttheeffectivenessof officesterilizers
• Lookatwaterlinesafetyafterpracticereduction
• Considerbathroomcleanliness
• Forrewards:havelistandhavestaffretrieveandgivetochild–notoybins
Viral numbers and aerosols:
• Considermouthrinsetoreduceviralload
• Rubberdamusetoreducepathogentransmission
• N95maskuseandotherPPEfordentistandstaffbasedonproceduresandproximity
• SalivaejectorvsIsolitetypesuctions
• Possiblywearastandardsurgicalmaskoverthen95masktopreservethen95mask
• Wearafaceshieldovermask
UVC:
• Considerultravioletlightsanitizers
HEPA:
• ConsiderHEPAairpurifiers
Single Use Equipment:
• Identifyonetimedisposablearmamentariumthathassterilizableandmulti-usecounterpartsandsolutionssuchasnitrousoxidecircuits/masksandlaunderedgowns.
• Newdisposablerecommendations(egN2O)
Nitrous Oxide Sterilization:
• Tubes,masks,bags
• If sterilizing,verifyyourtubing/bagscanbesterilized
Miscellaneous:
• Identifyandevaluatepotentialdeficienciesininfectioncontrolandthenmitigatethroughdevelopmentof interimbestpracticesuntilformalfederalguidelinesareestablished(e.gaerosolsandnitrousoxidebreathingcircuits)
ForCOVID-19
resourcesfromthe
AAPD,visitthe
AAPDCOVID-19
UpdateCenterat
aapd.org.
12 Re-emergence Pediatric Dentistry PRACTICE CHECKLIST
• OSHA:IndoorAirQualityinCommercialandInstitu-tionalBuildings
• OSHA:LetteronRegulationonRespiratoryProtectionforM.tuberculosis
• OSHA:TemporaryEnforcementGuidance-Health-careRespiratoryProtectionAnnualFit-TestingforN95FilteringFacepiecesDuringtheCOVID-19Outbreak
• OSHATraining:MedicalEvaluationforWorkersWhoUseRespirators
• OSHATraining:RespiratorFitTesting
• NIH:Decontaminationof N-95Masks
• NIOSH:Aerosols
• NIOSH:HealthcareRespiratoryProtectionResources
• NIOSH:IndoorEnvironmentalQuality
• NIOSH:TBInfectionControlPractices
• 2020COVID-19CoronavirusUltravioletSusceptibility
• PorterInstrument_NitrousOxideScavengerSystem:DoubleMaskBreathingCircuit
• PorterScavengerRubberGoodsSystemUserInstruc-tionsforAssembly,InstallationandCleaning
• ThePorterDisposableSilhouetteNasalMaskImprovesInfectionControlSafety
• TurbulentGasCloudsandRespiratoryPathogenEmis-sions
• RAMedicalServicesLtd:InfectionControlGuidetoCareof InhalationSedation
• RDH:HighVolumeEvacuation:Aerosols-It’swhatyoucan’tseethatcanhurtyou
• TimmermanMF,MensoL,SteinfortJ,vanWinkel-hoffAJ,vanderWeijenGA.Atmosphericcontami-nationduringultrasonicscaling.JClinPeriodontol.2004;31:458-462
• Transmissionroutesof 2019-nCoVandcontrolsindentalpractice
• WHO:NaturalVentilationforInfectionControlinHealthCareSettings
RESOURCESResourcesaremeantforbackgrounduseandarenotinchronologicalorder.Usersareadvisedtoverifyaccuracy.
Re-emergence Pediatric Dentistry PRACTICE CHECKLIST 13
PRACTICE MANAGEMENT CONSIDERATIONS
Nooneisreallysurehowthepracticeof pediatricdentistrywillevolveastheresultof thepandemic,butthebestadviceistobepreparedbyvalidatingrelationshipsandfinancialpathwaysbeforebeginningareturntopractice.Theresourcesofferedreflectapointintimesetof suggestions,buttherealitiesof theeconomiceffectsof thepandemiconpersonal,industrial,andgovernmentfinancessuggestthatpracticereadinessincludesathoroughandon-goingconsiderationof thebusinessaspectsof pediatricdentistry.
TOPICS AND CONSIDERATIONS RESOURCESResourcesaremeantforbackgrounduseandarenotinchronologicalorder.Usersareadvisedtoverifyaccuracy.If an owner of a practice:
• Didyoulay-offorfurloughyourstaff?
• Estimatecostsof salariesnotpaid
• Howdidyouengagethestaffduringtheshutdown?
• Describetheestimatedoverheadcostlossesduringthisperiod
• Estimatetherevenuelossesduringthisperiod
• Estimateof incomenotrealizedfor:routineexams,restorative,allcarerendered?
• DidyouapplyforaSBAEIDL(EconomicInjuryDisas-terLoan)?
• DidyouapplyforaSBAPPPloan?
• Didyouaskyourmainpracticelenderbankforothersourcesof relief fromcurrentloanpaymentssuchasdeferredpayment,interest-onlypayments,and/orshort-termlowinterestloans?
• Didyoupetitionyourlandlordforadelayinrentpay-ments?
• Areyouconsideringdownsizingyourpractice?
• Willyouberehiringallof youremployees?
• AAOOfficeStaffandHRFAQ’s
• DeltaDentalmembercompaniesbeginofferingfinan-cialassistanceduringpandemic
• PaycheckProtectionProgram(PPP)Update[NEW4/24/20]
If you are associated with local hospitals, describe your role during the crisis:
• Didyoucontributeyourofficeresources(PPE)tothehospitalsduringthecrisis?
• Wereyouexcludedfromaccesstooperatingrooms?
Insurance and payer considerations:
• Becomefamiliarwithpotentialcoverageforteledentist-ry,andnewcodesforCOVID-19testing
• Followupwithinsurerswhomaybeassistingwithfinancialissuesfromcrisis
ForCOVID-19
resourcesfromthe
AAPD,visitthe
AAPDCOVID-19
UpdateCenterat
aapd.org.
• Follow-upwithinsurerswhomayprovidemoreflexibili-tyintermsof timingforsixthmonthrecallvisits
• Howtodealwithnewlyunemployedyetrecurringparentsoremployerswhosehealthbenefitshaveceasedduetheirliabilities
• Trackpossiblechangesimplementedby insurancecarriersinresponsetocrisis
Medicaid and public considerations:
• DidFQHCs,publichealthfacilities,orcorporate practicesrampupemployment?
• WillMedicaidrollsswellandswamppediatric practices?
• WillstatesmaintainPerMemberPerMonth(PMPM)toManagedCareOrganizations(MCO)toassurepayment?
• WilldecreasedstaterevenuesaffectMedicaiddentalcare?
• ShouldyoufileanyunsubmittedMedicaidclaims?
• Willpandemicbecomeanexcuseforproblems/delays?
• IsMedicaidinyourstateprovidingfinancialadvancesorgrants?
If you are an associate or employee dentist, describe the liability costs you incurred during this time:
• Incomenotrealized
• Educationalloans
• Refinanceloans
For pending grads and new grads:
• Didtheprogramconfercompletionof certificate despiteshortfallof tenureof theprogram?
• Weretherelicensingchallengespost-programinthestateyoumovedto?
• Werethereemploymentchallenges?(Underlyingassumption-existingprivatepracticesarecatchingupforlossessustainedandwouldminimizeadditionaloverhead)
• Whatwereyourloanliabilitiesoncompletionof yourresidency?
Private third party compliance oversight:
• Contractingoutsideconsultant(s)forspecifiedobjectives
• Doacross-disciplinepracticereview:legal,clinical,OSHA,accounting,insurance,andotherelementsasneeded
TOPICS AND CONSIDERATIONS