there are also things that we can do during any pandemic that will help us
all stay healthy. one is to minimize the time in the
waiting rooms and encourage spacing emergency patients six feet apart if
waiting is necessary. again, keeping in mind, that this is for treating emergency
patients and patients with urgent needs only. consider having patients wait in
their car to be called in by phone or text message when the dental chair is
available. if you need to see more than one patient at a time,
you can exercise social distancing in the treatment areas, by either putting
patients in individual rooms, or in larger facilities where there may be
cubicles for dental treatment areas, distancing those patients at least six
feet apart. and, when you're providing services in an integrated health system
with medical services, you should consult with your medical colleagues to review
your protocols, and also make adjustments that may be needed to the above steps.
some of these integrated healthcare systems may have stricter
recommendations because they're under certain accrediting or certification
bodies. and, we need to get back to the basics and remind ourselves of what are
the types of infection control precautions that we take with every
patient, and take these while you're providing urgent care to your patients. and, that is
the standard use of PPE. selecting the type and the amount of PPE is still
based on the same concepts. if you're doing procedures that may produce a
spray or a spatter of oral fluids you should wear eye protection, a mask, a
gown, and gloves. and, those should be changed according to existing guidelines.
sterilization of critical critical and semi critical instruments should
continue, as well as surface disinfection. and, the EPA has helped by posting a list
of disinfectants that are effective against coronavirus on their website.
you'll need your EPA number that's on the manufacturer's label for your product
in order to see whether or not what you're using has been shown to be
effective against coronavirus. continue handling sharps safely and disposing of
sharps appropriately. and, now is a really good time to reinforce training.
it's never a bad time to remind people of what our infection control
precautions are and why we do them. and, this training is really critical to us
now. it's also important to know the difference between a surgical mask and a
respirator because we've seen so many of these come up now. in dentistry, we're not
accustomed to using respirators on a regular basis and may not truly be
prepared to do so. a surgical mask protects the mucus membranes of the
wearer from contact with the patient body fluids. it can also be worn by a
patient with a respiratory illness if they're coughing or sneezing to
reduce the number of droplets that are released into the air when they're in
contact with other people. a medical n95 respirator filters particles to prevent
them from reaching the respiratory tract of the wearer. different types of n95
respirators are available. there are some that are labeled as
medical use. and, usually those would be the only ones that would be appropriate
in providing care to patients under certain circumstances. but, because of
this shortage, OSHA, the CDC, and the FDA have agreed that healthcare workers
treating active COVID-19 patients may use n95 respirators that are not labeled
for medical use. however, they still need to comply with the other requirements
for preparing one to use a respirator. and, those requirements include, a written
respiratory protection program, and that employers Institute engineering and work
practice controls before resorting to PPE as a measure to protect workers. and,
that's always the case. if we can remove or isolate the hazard , rather than using
protective equipment, that is always preferable. before an employee can use can
n95 respirator, they must have a medical exam by a qualified healthcare
provider. that healthcare care provider will have them complete a questionnaire, and
based on the answers to that questionnaire, they may or may not need a physical
medical exam. they also need to have an fit testing of the respirator that they
will be using and receive specific training, including training on COVID-19.
OSHA has modified some of the requirements and could still modify them
further. so, before undertaking the use of n95 respirators you should look to the
OSHA website to see what changes may have occurred. there's a lot of
terminology that's kind of new to us, and making sure that we understand what it
means is important. social distancing is a way to mitigate the spread of disease
by keeping people apart from one another. and, the cdc website provides a lot of
guidance on how we can mitigate the transfer of diseases in the community
settings and also in the health care settings. now exactly what social
distancing is, in terms of what our local health departments are asking us to do,
can vary depending on a lot of factors. and, the CDC does provide those health
agencies with guidance on how to decide which measures are appropriate for that
local community. and, these are all currently being decided on local. by that,
I mean city and county level, and on state level. I think we all know that
yesterday, the governor of California issued a statewide shelter in place, and
the governor of New York did the same today.
implementing mitigation strategies and communities with low levels of
transmission may still be effective in reducing overall infection rates. and,
that's why, they're asked, the White House is asking all people in the United
States to take these measures. we have school closures even in areas where
there may not be any cases in that city. we need to limit our social activities
and gatherings, including events and faith-based services. reconsider any
non-essential travel. and, increasingly it's becoming more and more difficult to
travel by air even if we wanted to. develop work from home, and if you can,
relax sick leave policies, so if we do have a need to go to work to treat
urgent care patients, that people who are ill know that they
stay home. we also hear the term shelter in place.
and, shelter in place is generally an increased effort to distance people from
each other to slow the spread of infections. and, that would include
closure of non-essential businesses, such as retail outlets; orders to remain at
home with their household contacts only; and only leave your house for essential
needs, such as groceries and prescriptions. and, increasingly we're
seeing this level of precaution being implemented, especially in areas where we
know we have higher, ongoing community transmissions; limiting businesses that
must stay open to essential functions — essential personnel; and they also may
impose restrictions on hours that these can remain open. and, all of this is done
as part of their effort that we talked about earlier, which is flattening the
curve. I think that's going to be the saying of 2020. so, now I think we really
understand why we're reducing the practice to urgent care only. it's going
to help us limit contact with potentially infected individuals,
conserve those supplies of PPE for the most critical medical care, and we also
need to avoid becoming infected and spreading the infection to household
contacts and others. so, there are guidances on what type of
PPE and precautions that you can use in your practice when you're providing
urgent care to patients. and, on March 16th, again, the American Dental
Association recommended that all US dental practice limit treatment to
emergency or urgent procedures. and, we've also seen notices come out from state
and local dental associations. we've seen state boards of licensure require that
people close their practices to non urgent care. and, the CDC and the White
House have made these recommendations, as well. we talked about telemedicine, which
we don't have a lot of in dentistry. but, something that you can do is, instead of
having patients come in to be triaged for emergency care, provide that triage over
the phone. and, maybe you can determine whether or
not an in-person visit is really necessary. or, can they be assisted
through pharmacological means, or other types of advice or home care? if you have
a patient that be treated ask the screening questions
for COVID-19 risks so you can take the appropriate precautions. and, if the
person does not have COVID-19 or not at risk, provide standard precautions. and, if
somebody is ill, and you need to treat them then use droplet precautions, which
we'll talk about next. so, droplet precautions are in addition
to standard precautions. and, these precautions are used when treating
patients that are known or suspected to be infected with pathogens that are
transmitted by the respiratory droplets that are generated when a patient coughs,
sneezes, or talks and is infected with one of these pathogens. the recommendation
for that is, while the patient is waiting have them wear a mask. and, again that
reduces the spread to other people and the environment. place the patient in a
single room. and, then put a mask on yourself before you go into the patient
room, and leave it on until you leave, which is different than standard
precautions, which would be that you would remove the mask immediately after
treatment. in this case you want to leave it on until you're outside of the room
you can remove your gloves before you leave the room. wear a respirator if
you're treating patients diagnosed or being investigated for COVID-19. but, if
you don't have a respirator — [...] if the supplies are limited —
you can prioritize n95 respirators for procedures that generate
aerosols — respiratory aerosols, and wear a surgical mask for other procedures. you
can also consider the use of a face shield, in addition to a mask, to reduce
the potential for the mask becoming wet. there are other things that we can do,
too. we can try to prepare for when normal operations resume. because, they
will. you can clean and stock your clinics. you can follow any screening
protocols that are recommended by health authorities for accepting patients and
returning to work. because, when we come back there may be things that we need to
do before we can resume all of our normal operations. and, we'll need the
help of our health authorities and experts to guide us in what those steps
might be. if you currently have excess stock of PPE
that's critically needed for frontline health care workers, consider contacting
your local hospital to see if you can share that excess stock. and, continue to
monitor reliable sources of information such as the CDC, ADA and OSAP.
[...]