COVID-19 Safety Protocol

COVID-19 SAFETY ASSURANCE PROTOCOL

Dear Patients,

Our team is excited to see you again soon! While we have enjoyed this gift of time with our families, much of our purpose is derived from serving you, our patients. We are acutely aware that all of you have been affected by COVID-19, either directly or indirectly. We hope returning to our dental practice will provide some normalcy to your life.

As we prepare to return to work, a nine-step approach has been developed to create the safest environment possible for us to treat you, our patients, while we await a vaccine for the SARS CoV-2 virus to be developed and implemented globally. By nature, most medical and dental procedures create risk due to the proximity of the providers and patients to one another during the physical interaction required for visits. For this reason, we will take certain steps to ensure the safety of you and our team. The outline below will describe these steps in great detail, so you can be assured we are able to provide care in a low-risk environment where you have the comfort of knowing that everything that can be done is being done to protect you and our team.

Contents

1. Training and Educating Our Team
2. Recommendations for Our Team
3. Patient Interviews and Social Distancing Measures Upon Arrival
4. Measures Taken Upon Patient Entry to the Clinic
5. Reception Room and Front Desk
6. Safety Measures
7. Protocols of the Clinical Team
8. Patients in the Operatory
9. Protocols After the Clinical Treatment

1. TRAINING AND EDUCATING OUR TEAM

Our team has had refresher training in proper hand-washing techniques. This may seem basic; however, it is the most important thing we can do to prevent spread of the virus, yet research shows that it is often poorly complied with and usually not done well. Consequently, we have spent a lot of time ensuring that our team does it well and often, especially before and after every patient encounter.

We have practiced the appropriate use of personal protective equipment (PPE) prior to caring for a patient to prevent contamination.

We require staff members that are not feeling well to proactively stay home.

We take temperatures of all staff members at the beginning of every day, and we will immediately send home anyone with an elevated temperature (100.2 F and above).

We have created a specific checklist of recommendations for our team to follow so that we arrive to work healthy and go home to our families without worry (see Recommendations for Our Team).

2. RECOMMENDATIONS FOR OUR TEAM

  • Take temperature (do not go in to work if you or any other family member are experiencing symptoms: cough, sore throat, fever, etc.).
  • Remove jewelry and rings and leave at home.
  • Tie hair up, keep nails short and avoid extra accessories.
  • Place phone in a Ziploc bag that you will discard at the end of the day. If bringing a lunch, place in disposable wrapping.
  • Bring work clothes in a washable bag (i.e., pillowcase).
  • Team members have practiced the appropriate use of personal protective equipment (PPE) prior to caring for a patient to prevent contamination.

At Work

  • Change into scrubs and work shoes (preferably vinyl or plastic and wipeable) as soon as you arrive.
  • Use PPE as appropriate.
  • Leave all clutter (pens, phones, etc.) outside of patient op. rooms.
  • We discourage workers from using other workers’ phones, desks, offices, and other work tools and equipment when possible.
  • Clean phone handset after use.
  • Cell phone use is discouraged at work.

After Work

  • Wash hands and arms with soap.
  • Remove scrubs and place in washable bag or leave at work to be laundered.
  • Wash hands and put clean clothes on.
  • Sanitize phone, glasses, etc.
  • Wash hands again.

At Home

  • Do not touch anything.
  • Remove shoes and clothes.
  • Wash clothes and scrubs in washing machine with detergent and hot water.
  • Shower immediately with soap and water before touching anything (including loved ones).
  • ALL these measures can help to prevent transmission to others.

3. PATIENT VISITS AND SOCIAL DISTANCING

Before patient arrival, every effort is made to:

  • Filter patients during the phone call when scheduling appointments for care using established and recommended screening checklists and scripts.
  • Prepare scripts and questions to recognize potential carriers.
  • Reschedule patients who show any signs of a cough or fever or who describe having any concerning warning signs.
  • Instruct patients to call ahead and reschedule their appointments if they develop symptoms of a respiratory infection (e.g., cough, sore throat or fever) on the days they are scheduled to be seen.

To Promote Social Distancing

  • We prioritize high-risk patients (immunocompromised, over 60 years old, etc.) for early-morning appointments so there is less contact with other people.
  • We are seating patients in their operatories as soon as possible to minimize the number of individuals in our reception area.
  • If a patient is being accompanied, their escort should wait in their car to limit the number of people in the waiting room and promote social distancing.
  • We utilize a “virtual” waiting room: Patients can opt to wait in their cars or outside the office, where they can be contacted by mobile phone when it is their turn to be treated.

Safety Measures Taken Upon Arrival

  • We frequently disinfect door handles. Where possible, doors will be left open.
  • We have posted visual alerts (e.g., signs, posters) at the entrance door advising patients of the COVID-19 risk and advising them not to enter the facility when ill.
  • Masks and tissues are made accessible immediately upon entry for patients without them.
  • We provide supplies such as alcohol-based hand rub (ABHR) with 60% to 95% alcohol, tissues, and no-touch receptacles for disposal at the entrance, in waiting rooms and at the front desk.

4. MEASURES UPON ARRIVAL

  • We will ask patients about the presence of symptoms of a respiratory infection and history of travel or contact with possible COVID-19 patients.
  • We will assess patients for respiratory symptoms and fever (with a noncontact digital infrared forehead thermometer), and they will be asked to complete screening forms.
  • If temperature of 100.2 F or higher or respiratory symptoms are present, they will be advised to seek medical treatment, and their visit will be rescheduled.
  • We will escort patients into an examination room as quickly as possible upon arrival to avoid lingering in the front office.
  • As testing for the virus becomes more available, we will be incorporating this added benefit to screen patients.

5. MEASURES TAKEN UPON PATIENT ENTRY TO THE CLINIC

  • We have removed all clutter and anything that is not easily disinfected from the waiting room (magazines, area rugs, pillows, toys, etc.).
  • We have covered all dental chairs with disposable covers, which will be replaced after each patient.
  • We are frequently wiping down waiting rooms, door handles, tables, light switches, computers, etc.

6. RECEPTION ROOM AND FRONT DESK SAFETY MEASURES

  • We have installed physical barriers or partitions (e.g., glass or plastic windows), if possible, at reception areas to limit close contact between reception and potentially infectious patients.
  • Headphone use is encouraged so hands are free and only one person uses it.

7. PROTOCOLS OF THE CLINICAL TEAM

  • We adhere to usual standard and transmission-based precautions in operatory but with greater attention to detail and ensure that procedures are followed consistently and correctly.
  • Furthermore, we will employ an additional team member or assistant whose main focus is on only sterilization. This team member will be responsible for disinfecting and wiping down everything in the waiting room, such as chairs, handles, light switches, tables, etc., on a regular basis.

Hand Hygiene Is Performed by Our Staff

  • Before and after all patient contact, contact with potentially infectious material, and before putting on and after removing personal protective equipment (PPE), including gloves.
  • After removing PPE in order to remove any pathogens that might have been transferred to bare hands during the removal process.
  • Washing hands with soap and water or sanitizer for at least 20 seconds.

Personal Protective Equipment

  • Wear PPE (masks, gloves, cap, eye protection, face shields, gowns when around confirmed cases).
  • Masks are one-time use and replaced if soiled.
  • N95 respirators will be used with mask covers when available instead of surgical masks when performing or present for aerosol-generating procedures.

Eye Protection

  • Put on eye protection (i.e., goggles or a disposable face shield that covers the front and sides of the face) upon entry to the patient room or care area.
  • Remove face shields before leaving the patient room or care area.
  • Reusable eye protection (e.g., face shields) must be cleaned and disinfected according to manufacturer’s reprocessing instructions prior to reuse.
  • Disposable eye protection should be discarded after use.

Gloves

  • Put on clean, nonsterile gloves upon entry into the patient room or care area.
  • Change gloves if they become torn or heavily contaminated.
  • Remove and discard gloves when leaving the patient room or care area and immediately perform hand hygiene.

Gowns

  • Put on a clean isolation gown upon entry into the procedure room or area.
  • Change the gown if it becomes soiled. Remove and discard the gown in a dedicated container for waste or linen before leaving the patient room or care area. Disposable gowns should be discarded, and cloth gowns should be laundered after each use.
  • Gowns should be prioritized for all aerosol-generating procedures and during activities where splashes and sprays are anticipated.

8. PATIENTS IN THE OPERATORY

  • Healthcare personnel (HCP) should strictly follow basic infection control practices between patients (e.g., hand hygiene, cleaning and disinfecting shared equipment).
  • Limit transport and movement of the patient outside of the room.
  • 2D imaging to be completed in patient operatories to reduce patient movement throughout office.
  • No other team member should enter the room during a procedure and, if necessary, should use PPE as described above.
  • Once the patient has left the operatory, HCP without adequate PPE should refrain from entering the op. until sufficient time has elapsed for our air purifiers to remove potentially infectious particles.
  • After this time has elapsed, the room should undergo appropriate cleaning and surface disinfection before it is returned to routine use

9. PROTOCOLS AFTER THE CLINICAL TREATMENT

  • All nondisposable medical equipment used for patient care should be cleaned and disinfected according to manufacturer’s instructions.
  • Ensure that environmental cleaning and disinfection procedures are followed consistently and correctly.
  • Routine cleaning and disinfection procedures (e.g., using cleaners and water to preclean surfaces prior to applying an EPA-registered, hospital-grade disinfectant to frequently touched surfaces or objects for appropriate contact times as indicated on the product’s label) are appropriate for SARS-CoV-2 in healthcare settings, including those patient-care areas in which aerosol-generating procedures are performed.

Safety Measures After the Visit

  • Encourage contactless payment methods to minimize contact with front desk personnel.
  • Review of estimates and insurance forms can be carried out via phone call or video conferencing and sent via mail for signature and payment.
  • All forms have been modified to be emailed to patients so they can be signed on the patient’s own device to avoid contact.
  • Teledentistry follow-up visits will be offered for surgical patients.
  • We are confident that these guidelines will help to create a safe environment for all of our patients and team members and hope that you can feel secure in the knowledge that we are doing everything in our power to provide the safest clinical conditions in order to protect our patients, team and families.