Transmission-based precautions might include patient placement (e.g., isolation), adequate room ventilation, respiratory protection (e.g., N-95 masks) for dental personnel, COVID-19 pandemic In March 2020, after the worldwide outbreak of the highly contagious coronavirus, COVID-19, multiple regulatory agencies including the American Dental Association, the Centers for Disease Control and Prevention, and the Centers for Medicare and Medicaid Services recommended that dental offices postpone elective procedures, surgeries, and non- urgent dental visits, and prioritize urgent and emergency visits (ADA, 2020a: CDC, 2020a; CMS 2020). Because the virus is transmitted through respiratory droplets and because of the proximity of the provider to the patient, dental practitioners have one of the highest risks of exposure. For urgent care of patients with known or suspected COVID-19, dental personnel should work together to determine an appropriate facility and should follow the interim Infection Prevention and Control Recommendations for Patients with Confirmed Coronavirus Disease 2019 or Persons Under Investigation for COVID-19 in Healthcare Settings. The key concepts in this guidance include the following:
or postponement of nonemergency dental procedures (Terezhalmy, 2018).
● Limit how germs can enter the facility. Cancel elective procedures, use telemedicine when possible, limit points of entry and manage visitors, screen patients for COVID-19 symptoms, encourage patient respiratory hygiene using alternatives to facemasks (e.g., tissues to cover cough). ● Isolate symptomatic patients as soon as possible. Set up separate, well-ventilated triage areas, place patients with suspected or confirmed COVID-19 in private rooms with the door closed and a private bathroom (as possible), prioritize airborne infection isolation rooms (AIIRs) for patients undergoing aerosol-generating procedures. ● Protect healthcare personnel. Emphasize hand hygiene, install barriers to limit contact with patients at triage, cohort COVID-19 patients, limit the numbers of staff providing their care, prioritize respirators and AIIRs for aerosol-generating procedures, implement PPE optimization strategies to extend supplies. (CDC, 2020a)
INFECTION PREVENTION CHECKLIST FOR DENTAL SETTINGS
dental healthcare settings and allows dental personnel access to an interactive version of the checklist in a portable, easy- to-use, and streamlined format. App users check “Yes/No” to acknowledge compliance with a list of administrative policies or observed practices and results may be exported to facilitate records management. DentalCheck also provides links to full guidelines and source documents that users can reference for more detailed background and recommendations. The Summary does not provide specific recommendations regarding frequency of checklist usage; however, the CDC provides guidelines (and OSHA provides regulations) regarding initial, additional, and annual training of dental personnel. These checklists may be utilized during any phase of education and training. Recommendations for training include the following: ● Initial training : ○ Changes in responsibilities of staff or infection control manager. ○ Changes in office procedures where there is a potential of an occupational exposure/hazard. ○ Changes in government regulations or recommendations. ● Additional training : ○ Changes in policies, procedures, or products. ○ If new information is available or if there are changes in recommendations or regulations. ○ If someone does not follow standard operating procedures. ● Annual training : ○ Required for specific OSHA standards such as the Bloodborne Pathogens Standard. ○ Recommended as good office policy. (OSAP, 2019) Points to Consider: 1. If instruments will ultimately be sterilized in the autoclave, does it matter if dried and crusted debris remains on the instruments? If debris is not removed, it will interfere with microbial inactivation and can compromise the disinfection or sterilization process. Thus, the sterility of the instrument could not be guaranteed. Cleaning is the first step in any disinfection or sterilization process and all visible debris must be removed prior to sterilization.
The Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care contains a two-part checklist to assess practices and ensure that the minimum expectations for safe care are met. Evaluation offers an opportunity to improve the effectiveness of both the infection- control program and dental-practice protocols. If deficiencies or problems in the implementation of infection control procedures are identified, further evaluation is needed to eliminate the problems (CDC, 2016a). The first part focuses on policies and practices of a dental facility. This checklist serves as a tool to enhance understanding of underlying principles, recommended practices, and their implementation. It helps the staff assess whether a dental facility has appropriate infection prevention policies and practices in place, appropriate training for team members, and adequate supplies to provide safe care and a safe working environment. The second part involves direct observation of personnel and patient-care practices. This checklist provides a review of practices for basic expectations for safe dental care, aids in standardizing infection control protocol and enhancing compliance with existing CDC Guidelines , and provides feedback to dental personnel regarding performance. The full checklist is available in a separate printable PDF format and an electronic fillable format PDF. The fillable format allows users to type info into the PDF form and electronically save the evaluation documentation. In 2017, the CDC created a mobile app version of the Summary and checklist. “DentalCheck” is available for free download at the Apple iTunes store and is available for mobile iOS devices (iPhones or iPads). DentalCheck provides basic infection prevention principles and recommendations for
CASE SCENARIO #1
Dr. Smiley’s office was extremely busy on a Tuesday after a long holiday weekend. In addition to a full schedule, three emergency patients needed to be seen that day. There seemed to be no time to immediately process instruments so personnel took contaminated instruments to the instrument processing area and left them on the countertop until clinical personnel could attend to them. Several hours later, Jessica, the hygienist, had some time to dedicate to instrument processing. She noted dried and crusted organic debris on her periodontal scaling instruments, and dried blood on her mouth mirrors.
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