CoronaVirus #6: Opening Back the Dental Office.

CoronaVirus #6: Opening Back the Dental Office.

Top 5 Things to Consider Before
Returning to the Dental Office

Linda did a  National Podcast for Dental Podcast Network and thought after she finished it would be a great idea to send all of our Dental Healthcare the information so you are prepared to open up your offices safely.

Name:  Linda Cannon
Occupation:  Regulatory Compliance Specialist, and Authorized by the Dept. Of Health to teach up to a 30 hour OSHA Class.
Whom Do You Teach: I’m Exclusive with Dental Healthcare Providers
Your Background:
Civil Servant with the Naval Dental Clinic.
Private Dental Office
Dental Sales Rep – National Company
AHA BLS-CPR Instructor Trainer
Starting our Company, MSDS.
Paramedic Program with TCC
Full Time with MSDS
Start-up of Dental Business Network
Fellow of Speaker Consulting Network
Going strong for 32 years in safety!!
Skip this as the Podcast is National and other states have different dates and extentions.

VA:  Dentists have always been able to see Patients for urgent care or emergencies.
May 8th is the extension for the non-healthcare companies to open.
Gov. Ralph Northam Wants the Dental Healthcare offices to only see emergency patients through April 24, 2020.  Then they can start seeing Patients again for routine visits.
And all of this could change.  Everyday our lives are on a teeter totter.
From the ADA: They would prefer after April 30th for all states to start seeing Patients for routine visits.

However, what we have to take into account:
Social Distancing still has to be in place.
PPE as per CDC has to be also in place.  This includes / Face Shields, Masks, Gloves, Gowns, etc.
Most dental offices  don’t have, and many sent what they did have to the hospitals.  ….They may have a hard time getting the proper PPE.  CDC states if you can’t get the proper PPE, send your patients to someone who can.
It’s should be interesting how everything will be played out.

Hi Amanda!  Thank you so much for the invite!
Key:  HCDO:  Healthcare Dental Office.

1^st to Consider Before Returning to the HCDO:  Patients

Healthcare Dental offices need to decide how they will keep Pt.’s at the 6 foot social distance. Try to keep a 10 foot for anytime there is no masks or gloves. This alone is not going to be easy task.
They need to Screen the Patients before being seen.  I have added the Screening at the end of this doc for you to view along with signs and symptoms of Covid-19.
If your Clerical staff can’t stay back that much, they need to wear safety glasses and a mask.
Don’t worry, if they aren’t used to them already, they will be!
Personally,  I think bringing patients in from their vehicle through texting, is still the best way to keep -the virus thoughts, from the patients mind, at ease.

2^nd to Consider Before Returning to the HCDO:  Clerical Staff

Then you have the updated medical history that must be completed every year or more if medically compromised.
Personally, if you don’t have an iPad or signature pad…that you can wipe down, you may want the Patient to complete, hand it to the clerical staff (who will need to wear gloves and they can wash their gloves with hand sanitizer or a surface disinfectant) and then review for changes.
No changes take a picture with an office phone or scan it and then shred. You can print out the picture or scanned doc for their file.
Wearing Nitrile Gloves and wiping them with a disinfectant wipe may prove to be an easier solution.

3rd to Consider Before Returning to the HCDO:  Clinical Staff Prior to Start

Prior to seeing Patients:  Autoclaves, Spore Tests, Ultrasonic, and water lines must be up to date if your office has closed and not seen emergency patients.  Otherwise, most offices should be ready to see the first patient.
Uniforms are allowed to be worn into the office.  Then your PPE, spell it out.  Should be ready to be worn, in working order, and in size appropriate.
Joint commission is stating that Staff Members may bring in comparable PPE – if they feel that they are more comfortable in Safety than what the dentist is providing, or that the dentist cannot provide… because of limitations. Many DIY PPE is working great.


*4^th to Consider Before Returning to the HCDO:  Clinical Staff Treating Pt.’s***

If only hand scaling, and hand polishing, then only normal PPE is required.  Mask, gloves, safety glasses with side shields, and a lab jacket.
If using Cavitron, handpiece, Prophy-jet, anything that will allow the large particle droplets to become aerosols, you need to add a Face Shield, P95 Mask, and a disposable gown.
**They did not say it’s a requirement but personally I would cover my hair with a disposable shower cap. This is what the hospitals are doing.
ALL products need to be wiped down.  I suggest you cover or put away the products, between the use of the handpiece, cavitron and prophy-jet.

5^th to Consider Before Returning to the HCDO:  Clinical Staff End of Patient Care*
It is suggested to wash your Nitrile gloves with Soap & Water, followed by using hand sanitizer or a surface disinfectant wipe.
Then take off your autoclave-able gown inside out and prepare the autoclave pouch.
Wash your nitrile gloves.
Now take off your face shield and clean with soap and water.
Wash your gloves.
Take off your disposable shower cap and throw it away
*And you guessed it, wash your gloves.

**If you’re prepared to see the next patient – the hospitals are allowing the P95 mask, if it’s under a face shield to be worn more than once.
At the end of the day it goes into an autoclave bag and should be autoclaved.

Now you’re ready to go home.*
The suggestion from the hospitals are to have a change of clothes, and any uniform you’ve used is bagged and carried home and placed directly in the washer.
Any reasonable PPE that can’t be wiped down should be placed in your washing machine at the office.
And any system that’s been in place – offices may find that company is closed.  If this is true, they may need to follow the same instructions…as the hospitals and bag everything and put it directly in your washing machine when you get home.

Leaving the office.
I would put on nitrile gloves, take a surface disinfectant wipe, use that to open up the door handles to the outside, and for your car door.
Fold the surface disinfectant into your gloves, remove gloves, and place them in a Ziploc bag so that you can throw away in the trash before you enter in your home.
When you get home immediately disrobe.  Keep your kids, house members including animals away from you.
Throw everything you’ve been wearing into the washing machine, including your uniform, as you don’t know what aerosols have fallen on the clothes you change into.
Don’t touch anything and go take a shower!  After YOUR destress Shower….
Relax and enjoy your family!!

** I know I’m being very strict, however, if you speak to your staff members and say
this is what we can do, would you feel comfortable and safe with this policy?
We think – you will find  – they’re a lot more acceptable to come back to work when they know there are very strict office guidelines to keep them safe and their family safe.

See Screening Patients Below:

From Harvard –   coronavirus-resource-center
And the Columbia University Irving Medical Center

These Symptoms Might Start Before Other Symptoms

Gastrointestinal (Gi) Symptoms, May Occur With Or Without Respiratory Symptoms:
Abdominal Pain Or Discomfort
Loss Of Appetite
Nausea
Vomiting
Diarrhea (Virus That Causes Covid-19 Has Also Been Detected In Stool)

Typical Signs:
Fever
Dry Cough
Fatigue
Loss Of Smell
And Body Ache
Low Blood Oxygen Levels down in the 90 to 93 continuously but be couscous of other underlying issues. (Watches with Health Apps are being evaluated to help patients with early signs to stay indoors or seek Medical Attention – They are too volatile currently to use). Also some Pulse Ox’s are not FDA Approved.  If you are using them, go with a diary of time taken.  (ConsumerReports.com)

Neurological Symptoms, May Occur With Or Without Respiratory Symptoms:
Loss Of Smell
Inability To Taste
Muscle Weakness
Tingling Or Numbness In The Hands And Feet
Dizziness
Confusion
Delirium
Seizures
Stroke

New Advanced Signs “Neurological”:

Encephalitis
Meningitis

Typical Advanced Signs:

High Fever
Severe Cough
Shortness Of Breath (Sign of Pneumonia)

New Advanced Signs Emerging:

Pink Eye
Blood Vessel Constriction
Kidney Damage
Blood Clots

* Several Experts Believe That Direct Viral Invasion Isn’t Likely The Culprit for some of the New Advanced Signs.

hey Say Other Events In A Failing Body, Like Drugs Or An Immune System In Overdrive, Are More Likely Driving The Additional Damage. This map of the devastation that COVID-19 can inflict on the body is still just a sketch. It will take years of painstaking research to sharpen the picture of its reach, and the cascade of cardiovascular and immune effects it might set in motion. As science races ahead, from probing tissues under microscopes to testing drugs on patients, the hope is for treatments more wily than the virus that has stopped the world in its tracks.

Men Likely to Get Worse Symptoms Than Women?

The difference doesn’t appear to be caused by differential rates of infection: The New York study, for example, found that equal numbers of men and women catch the virus. But men are more likely to progress to severe illness and death.
-One possible reason for the sex difference is smoking
-Another possibility is that men – older men in particular – are in generally worse health than women.
-A possibly related idea is that women may naturally have stronger immune defenses.
-Men with covid-19 in hospital were also more likely to be carrying other viruses, including flu, and bacteria, and it is possible that this may increase the severity of covid-19 symptoms states one study.
-Another possibility is that men are simply less hygienic. This is where Dentists shine.  They are much more likely to be Hygienic then your typical male.  But all in all.  We all have to look at ourselves and try to improve as best we can.

Questions for Screening Patients:

What hospitals are asking:

– Do you Currently have a cold with breathing difficulty or had one within the last week?
– Do you currently have the flu with breathing difficulty or had one within the last week?
– Do you have any breathing difficulty currently or within the last week?
– Have you been anywhere near someone who has been diagnosed with the coronavirus?
– Have you been anywhere near someone who has traveled and has had any of these symptoms currently or within the last week?
– Have You Been Traveling Within The Last 14 Days?
– Do You Have A Fever?
– Do You Have A Cough?
– Age 65 Or Older?
– Immune Compromised From Being Sick, Surgery Or Medical Condition?

Feel free to add any part of the copy above or add to the questions.

Organizing your computer for MSDS:

Make a folder on your desktop named MSDS.
Double click the folder.
- Create Folders for each category. OSHA-BBP, OSHA Safety Classes, HIPAA, Medical Emergency, BLS-CPR, etc.
In each folder, for example, HIPAA:
- You’ll have the Business Associate Agreement, Patient Consent Form, Office’s Privacy Practice, etc.

MSDS
Linda L. Cannon
Director of Safety Compliance

Phone: 1-757-718-1515
Toll Free: 1-800-483-0223

Email: MSDS@cox.net

www.MSDSSafety.com

MSDS' best practices website is not a standard or regulation, and it creates no legal obligations, nor does it change any existing OSHA or other government standard or regulation. The guide is advisory in nature, informational in content, and is intended to assist employers in providing a safe and healthful workplace.