Training and Educating Our Team
One of the most important things we are doing during this time is to train and educate our team. Our office staff is already well equipped and trained in the use of PPE and Universal Precautions. COVID-19 presents some new issues which necessitate additional training and protocols
- Refresher training in proper hand washing techniques, as we do every year. This may seem basic; however, it is the most important thing we can do to prevent spread of the virus.
- Appropriate use of personal protective equipment (PPE) and the additional equipment we have installed to mitigate aerosol spread and to prevent contamination.
- Employees that are experiencing cold or flu-like symptoms are to stay home and to be evaluated for COVID-19 by a medical doctor.
- All employees will have their temperature taken at the beginning of every day; employees with temperatures above 100.4 will be sent home and evaluated for covid-19.
- O2 saturation will also be checked; low O2 saturation has been shown to be an early symptom of COVID-19 infection.
- Limiting the numbers of patients coming through the office. Limiting the volume of procedures that produce aerosols. More time in between patients to allow for room disinfection. Additional equipment to mitigate aerosols.
Before coming to work
- Take temperature (do not go in to work if you or any other family member are experiencing symptoms; cough, sore throat, fever…etc.)
- Remove watch and rings and leave at home.
- Tie hair up, keep nails short.
- Avoid extra accessories.
- Cell phones will remain in lockers or inside purses and will not be used during the work day. Supervisors may use their cell phone for business purposes only.
- Clinical staff should change into scrubs and work shoes (preferably plastic and wipeable) as soon as you arrive. Office staff should wear a lab coat to protect their personal clothing while in the office.
- Use PPE as appropriate.
- Refrain from using other employees’ phones, desks, offices and personal items as much as possible.
- Clean phone handsets before and after use.
- No cell phone use at work.
- Wash hands and arms with soap.
- Remove scrubs and leave at work where they will be laundered each day.
- Wash hands and put clean clothes on.
- Sanitize phone, glasses, and other personal items which may have been exposed to office aerosols.
- Wash hands again.
- Do not touch anything or anyone.
- Remove shoes and clothes.
- Wash clothes in washing machine with detergent and hot water.
- Shower immediately with soap and water before touching anything (including loved ones)
Patient Interviews and Social Distancing
When a staff member calls patients to confirm appointments, they will ask if the patient has any of the following symptoms:
- Fever over 100.4-measured by a thermometer.
- Shortness of breath.
- Dry cough.
- Runny nose.
- Sore throat.
- Reduction in a sense of smell and taste.
We will reschedule patients who show any signs of a cough or fever or who describe having any concerning warning signs.
We will instruct patients to call ahead and reschedule their appointment if they develop symptoms of a respiratory infection (e.g., cough, sore throat or fever) on the day they are scheduled to be seen.
We are drastically modifying our schedule for the near future. All dental visits will be longer and we will allow more time between appointments for additional infection control procedures. We will incorporate tele-dentistry as much as possible in our office for post-op visits and consultations that do not require in person visits.
To promote social distancing
- Spreading out the schedule to minimize the number of people passing through the waiting room; one at a time as much as possible.
- As much as possible have financials, consents, med hx and other paperwork completed and filled out ahead of time using tele-dentistry.
- If a patient is being accompanied, their escort should wait in the car to limit the number of people in the waiting room (2 max) and promote social distancing.
- We will be utilizing a “virtual” waiting room. Patients are to call when they arrive in the parking lot. They will remain in their car until their room is ready and the front desk calls or texts them to come in.
- There will be an assistant ready to bring them back to the operatory once financials are completed.
- All patients will be escorted through the side door upon completion of treatment.
- Limit points of entry-just through the front door.
- Leave office door open to avoid contact with door handles.
- Everyone entering the office should be wearing a mask.
- Post 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.
- Provide supplies such as alcohol-based hand rub (ABHR) with 60-95% alcohol, tissues and no-touch receptacles for disposal, at the entrance, in waiting rooms and at front desk.
Upon arrival to the office patient are:
- Asked about the presence of symptoms of a respiratory infection and history of travel or contact with possible COVID-19 patients.
- Assessed for respiratory symptoms and fever.
- If fever temperature of 100.4 degrees F or higher or respiratory symptoms are present, they will be evaluated to seek medical treatment and their visit will be rescheduled. Dental infections are also a reason for elevated temperatures.
- O2 saturation will be checked upon arrival.
- Consent completed, if not already done, stating they are aware of the risk of being in the dental office and COVID-19 Screening.
- Patients will then be escorted into an examination room.
- Asked to rinse with 1% hydrogen peroxide before each appointment.
- As information and testing for the virus becomes more available, we will be evaluating this added benefit to screen patients.
Reception Room and Front Desk Safety Measures
- We have a hospital grade large air filtration device in the reception area.
- Frequent wipe down of waiting rooms, bathrooms, door handles, tables, light switches, computers…etc.
- All surfaces are wiped down regularly with appropriate disinfectants.
- Plexiglass barriers on front counter between admin team and patients.
- Charts should only be handled by admin team and no longer taken to the treatment rooms. All paperwork should be handled at front desk before the patient goes back and should not go into treatment rooms. Health history can be given to doctor outside the room for review.
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 for at least 20 seconds.
Personal Protective Equipment for our team
- Wear PPE (masks, gloves, cap, eye protection, face shields, gowns)
- N95 masks and face shields are to be used during aerosol generating procedures.
- 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 eye protection before leaving the patient room or care area.
- Reusable eye protection must be cleaned and disinfected according to manufacturer’s reprocessing instructions prior to re-use.
- Put on clean, non-sterile gloves upon entry into the patient room or care area.
- Change gloves if they become torn or heavily contaminated during the procedure.
- Remove and discard gloves when leaving the patient room or care area, and immediately perform hand hygiene.
- Gowns will be used for all aerosol-generating procedures and during activities where splashes and sprays are anticipated.
- Gowns will be changed 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 will be discarded and cloth gowns will be laundered daily.
Patients in the Operatory
- All employees 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.
- No other team member should enter the room during a procedure and if necessary, should use PPE as described above.
- Special precautions will be taken when performing aerosol generating procedures (AGP), in particular, procedures that are likely to induce coughing are avoided if possible.
- Our hygiene team will limit the use of ultrasonics unless absolutely necessary.
- After the patient has left, the room should undergo appropriate cleaning and surface disinfection before it is returned to routine use.
Additional Equipment we have installed:
- Each operatory has been equipped with a powerful air filtration system that removes particles from the air.
- We have installed extra-oral devices to aid in aerosol removal.
- We have installed UV devices in our air conditioning and heating ducts to kill viruses and bacteria.
Treatment Planning & Financial Disclosure Forms:
Our standard practice of reviewing treatment plans and financials prior to care will continue to be followed. Treatment plans will be presented by the administrative team via email or phone whenever possible or in the front office while wearing a mask. If a patient has to sign a document mid treatment, they will put their mask back on and step into the hall to review and sign with the administrative team. A sanitized clipboard and pen will be provided.
Protocols After the Clinical Treatment
- All non-disposable medical equipment used for patient care should be cleaned and disinfected according to manufacturer’s instructions.
- Proper cleaning and disinfection procedures will be followed.
Safety Measures After the Visit
- The patient will be escorted out through the side door to comply with social distancing guidelines.
- Patients wash hands before leaving.