MDP and COVID-19 Update

Team, 

We wanted to take this opportunity to update you on our situation. The prevalence of COVID-19 has continued to grow. Please continue to reference the Team Member Exposure Policy and work with your Regional President to ensure we are taking appropriate actions at the individual and practice level. 

As a company we are working to serve our social responsibility to help “flatten the curve” while also caring for our patients’ essential dental needs. As healthcare providers we play an essential role in managing dental emergencies which can lighten the workload on our local hospitals and urgent care facilities. We’ve seen communications from multiple states emphasizing the importance of continuing our ability to provide essential care and avoid patient abandonment, this is true even in states that have instituted “Shelter in Place.” At the same time, we respect and support team members who feel unsafe or have personal circumstances that would prevent them from working. Circumstances could include medical conditions, child care, elder care or living with someone who may have a chronic illness or other health compromised conditions.

I’ve included below some guidelines for patient care as well as a literature review for mask protocols in the dental setting. I’ve also included a Message to KY healthcare providers from Dr.Stack, Commissioner for Public Health.

MDP COVID-19 Guidelines and Patient Care

All patients with no signs, symptoms or known exposure to COVID-19 virus

  • Pre-screen patients via text, email or phone call and reschedule if the patient has been exposed to a person with confirmed COVID-19, or if they have a cough, high temperature or other flu-like symptoms. Reschedule for treatment in 8 weeks. 
  • As the patient arrives at the office, ask if the patient has been exposed to a person with confirmed COVID-19, or if they have a cough, high temperature or other flu-like symptoms.  Take a temperature when the patient arrives and reschedule for treatment in 8 weeks if the temperature is at or above 100.4 degrees. 
  • Use full standard PPE practice protocols which have been in place for years and which you have been trained on.
  • 1% Hydrogen peroxide rinse prior to any treatment. 
  • If a procedure includes the use of an air powered high speed handpiece which produces aerosols, use the highest standard of surgical mask available for the procedure.  Make sure a high speed vacuum is used to minimize aerosol dispursions.  
  • It is critical we maintain and continue the highest levels of infection control in all areas of the practice.  Starting at the front door please disinfect door handles, countertops, bathrooms and other hard surfaces multiple times a day. Treatment areas must continue to provide a high level of standards for safety and cleanliness.  
  • Continue the practice of social distancing while seeing patients by wearing protective gear, not shaking hands and avoid talking to patients without keeping 6 feet of distance.  
  • We recommend that employees take their temperature daily and watch for signs of COVID-19. If an employee has a relevant temperature the employee should be dismissed for the day.

Patient has indicated direct exposure to someone with confirmed diagnosis of COVID-19 virus but not currently experiencing signs or symptoms of COVID-19 viral infection

  • Rescheduled for treatment in 8 weeks.  
  • If the patient has emergency care which the provider chooses to treat, follow the above guidelines and use the N95 masks for all clinical staff.

Patients showing signs, symptoms or confirmed to have COVID-19 viral infection

  • Rescheduled for treatment in 8 weeks.  
  • If the patient has emergency care which the provider chooses to treat, follow the above guidelines and use the N95 masks, gowns, face shields, surgical cap  for all clinical staff in a predetermined surgical operatory designed with proper ventilation and closed door.
  • If your practice does not have the level of Protection required to treat a COVID-19 patient described at this level, please contact your Regional President. Support for such patients may be available for referral and care within your region by one of our practices or referral care to a local hospital.

Literature Review for Mask protocols in the dental setting

Based on our current situation recommendations are changing rapidly. And I think it’s worth noting that not all resources are aligned on what best practices are. I’ve done my best to include the most up to date and pertinent information available.

FDA

N95 Respirators and Surgical Masks (Face Masks)

If worn properly, a surgical mask is meant to help block large-particle droplets, splashes, sprays, or splatter that may contain germs (viruses and bacteria), keeping it from reaching your mouth and nose. Surgical masks may also help reduce exposure of your saliva and respiratory secretions to others.

While a surgical mask may be effective in blocking splashes and large-particle droplets, a face mask, by design, does not filter or block very small particles in the air that may be transmitted by coughs, sneezes, or certain medical procedures. Surgical masks also do not provide complete protection from germs and other contaminants because of the loose fit between the surface of the face mask and your face.

Surgical masks are not intended to be used more than once. If your mask is damaged or soiled, or if breathing through the mask becomes difficult, you should remove the face mask, discard it safely, and replace it with a new one. To safely discard your mask, place it in a plastic bag and put it in the trash. Wash your hands after handling the used mask.

CDC

Infographic – Understanding the Difference, Surgical Mask, N95 Respirator

Morbidity and Mortality Weekly Report

Primary PPE used in oral health-care settings includes gloves, surgical masks, protective eyewear, face shields, and protective clothing (e.g., gowns and jackets). 

Masks, Protective Eyewear, Face Shields A surgical mask that covers both the nose and mouth and protective eyewear with solid side shields or a face shield should be worn by DHCP during procedures and patient-care activities likely to generate splashes or sprays of blood or body fluids.

The majority of surgical masks are not NIOSH-certified as respirators, do not protect the user adequately from exposure to TB, and do not satisfy OSHA requirements for respiratory protection (174,175). However, certain surgical masks (i.e., surgical N95 respirator) do meet the requirements and are certified by NIOSH as respirators. The level of protection a respirator provides is determined by the efficiency of the filter material for incoming air and how well the face piece fits or seals to the face (e.g., qualitatively or quantitatively tested in a reliable way to obtain a face-seal leakage of <10% and to fit the different facial sizes and characteristics of HCP). When respirators are used while treating patients with diseases requiring airborne-transmission precautions (e.g., TB), they should be used in the context of a complete respiratory protection program (175). This program should include training and fit testing to ensure an adequate seal between the edges of the respirator and the wearer’s face. Detailed information regarding respirator programs, including fit-test procedures are available at http://www.cdc.gov/niosh/99-143.html (174,176).

FDA-cleared surgical masks are designed to protect against splashes and sprays and are prioritized for use when such exposures are anticipated, including surgical procedures.

Strategies for Optimizing the Supply of Face Masks

ADA

ADA Coronavirus Center for Dentists

Dentists are urged to view the Centers for Disease Control and Prevention COVID-19 situation webpage for current insight. Standard precautions should be taken with all patients, at all times.


Availability of Personal Protective Equipment

The CDC has not changed its guidance on single-use disposable facemasks, which are regulated by FDA to be single use and should be worn once and discarded.

Page 41 of the CDC Guidelines for Infection Control in Dental Health-Care Settings has the following guidance:

  1. Wear a surgical mask and eye protection with solid side shields or a face shield to protect mucous membranes of the eyes, nose, and mouth during procedures likely to generate splashing or spattering of blood or other body fluids;
  2. Change masks between patients, or during patient treatment if the mask becomes wet.

OSHA

Guidance on Preparing Workplaces for COVID-19

Very High Exposure Risk Very high exposure risk jobs are those with high potential for exposure to known or suspected sources of COVID-19 during specific medical, postmortem, or laboratory procedures. Workers in this category include: ■ Healthcare workers (e.g., doctors, nurses, dentists, paramedics, emergency medical technicians) performing aerosol-generating procedures (e.g., intubation, cough induction procedures, bronchoscopies, some dental procedures and exams, or invasive specimen collection) on known or suspected COVID-19 patients.

Personal Protective Equipment (PPE) Most workers at high or very high exposure risk likely need to wear gloves, a gown, a face shield or goggles, and either a face mask or a respirator, depending on their job tasks and exposure risks. Those who work closely with (either in contact with or within 6 feet of) patients known to be, or suspected of being, infected with SARS-CoV-2, the virus that causes COVID-19, should wear respirators. In these instances, see the PPE section beginning on page 14 of this booklet, which provides more details about respirators. For the most up-to-date information, also visit OSHA’s COVID-19 webpage.

International Journal of Oral Science

Transmission routes of 2019-nCoV and controls in dental practice

Based on the possibility of the spread of 2019-nCoV infection, three-level protective measures of the dental professionals are recommended for specific situations. (1) Primary protection (standard protection for staff in clinical settings). Wearing disposable working cap, disposable surgical mask, and working clothes (white coat), using protective goggles or face shield, and disposable latex gloves or nitrile gloves if necessary. (2) Secondary protection (advanced protection for dental professionals). Wearing disposable doctor cap, disposable surgical mask, protective goggles, face shield, and working clothes (white coat) with disposable isolation clothing or surgical clothes outside, and disposable latex gloves. (3) Tertiary protection (strengthened protection when contact patient with suspected or confirmed 2019-nCoV infection). Although a patient with 2019-nCoV infection is not expected to be treated in the dental clinic, in the unlikely event that this does occur, and the dental professional cannot avoid close contact, special protective outwear is needed. If protective outwear is not available, working clothes (white coat) with extra disposable protective clothing outside should be worn. In addition, disposable doctor cap, protective goggles, face shield, disposable surgical mask, disposable latex gloves, and impermeable shoe cover should be worn.

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