I would like to thank you, the patients, for your patience and forbearance during over the last 2 months and for your understanding and cooperation whilst we implement new measures at the practice.
I intend to reopen the Practice on Monday 8th June initially to see those who have been coping with dental problems for the last 2 months and then phasing in the gradual return to providing the full complement of care depending on the coronavirus state of alert in England, the establishment of a reliable supply chain for procurement of the necessary Personal Protective Equipment (PPE) and the development of standard operating protocols.
In reopening the Practice I will be adhering to the guidance documents issued by: the Faculty of General Dental Practice, Denplan, the British Dental Association, Public Health England and the Chief Dental Officer.
This policy outlines the modifications to our usual procedures that I intend to employ once the practice reopens. It is not known at this time whether the procedures I am putting in place below are temporary or whether they will become a permanent feature of the way dental practices must be run to ensure patient and staff safety in the future. This is likely to be a ‘living’ document and to change in line with new scientific evidence over time.
The dental profession has always achieved a high standard of infection control having had to adapt to the challenges of other infectious diseases and the fear surrounding them in the past. There are always adaptations that have to be made and conforming with them gives safety and confidence.
In the Practice our normal cross-infection control protocols against infectious pathogens are already woven into all clinical activity carried out on the premises. A dental practice is already a very clean environment compared to public areas and there is no evidence of COVID-19 transmission occurring in the dental profession throughout the world. Researchers have collectively evaluated all of the updated guidance and observed what measures have been put in place in other countries and we feel that the measures which are outlined in this policy vastly reduce the risk of transmission. Please be assured that all of our staff both clinical and non-clinical will be complying with our updated procedures to reduce the risk of cross infection in both directions.
What this means in practice
Reducing the risk of transmission of Covid-19 in a workplace and clinical environment means effective social distancing or appropriate protection to allow the closer contact necessary for dental care, risk assessments of the health of all those on the premises and of the procedure to be carried out and hand and respiratory hygiene. I understand that patients and staff will have questions about the safety of the practice and so below I have set out the measures we will be using to reduce or mitigate the risk of infection transmission.
Due to the coronavirus epidemic different dental procedures currently now require different levels of PPE. I have very good stocks of PPE for low risk dental procedures like exams, denture making, simple extractions etc as these are what we used routinely before the pandemic. Since the emergence of this virus the requirement is now to use enhanced PPE for certain procedures that generate aerosols like filling and scaling teeth. There is a national shortage of the facemasks required to carry out the higher risk procedures. Often what is available is fake and therefore unusable or doesn’t conform to EU standards.
I buy all my PPE from a reputable dental supplier who also has government contracts to supply the NHS and having now been on a course to learn to fit test these masks I feel confident I know how to spot a fake and also am happy to wait until my supplier has these masks in stock which currently is towards the end of June. I am not prepared to put anyone’s health at risk by carrying out procedures without the appropriate PPE for a procedure and so initially stabilising problems without the use of drills will be the norm.
We are especially mindful that many dental treatments are aerosol-generating procedures (AGP’s). The coronavirus is spread in droplets, splatter and aerosols produced by an infected person coughing or sneezing and also by contact with surfaces contaminated with aerosol or contact from hands that have been coughed into.
It is difficult for us to carry out some dental procedures without generating aerosols which could be a theoretical source of infection and we obviously wish to keep this to a minimum. Currently the dental literature suggests:
- Our use of our normal high-volume suction reduces aerosol production by over 90%.
- The use of dental rubber dam where possible reduces bio aerosols by a further 30 to 90%
- Our regular surgical facemasks filter approximately 60% of remaining airborne particles.
- FFP2 and FFP3 masks filter 94% and 99% respectively of airborne particles in both directions (patient to clinician and clinician to patient).
I therefore feel that our normal dental procedures can be carried out with minimal risk by the use of high-volume suction, rubber dam and routine surgical or FFP2 masks as appropriate and thorough surface cleaning after the appointment.
I do not intend to bring my hygienist out of furlough for at least a month until I have established a good flow to maintain social distancing in the communal areas of the building like reception and stairways and also have the correct PPE for her to use commensurate with her practice.
All staff will be using personal protective equipment in line with current recommendations for their job role and procedure risk. We may look very different; whilst our masks may make us appear impersonal and distant, please be assured we are still the same friendly team underneath it all! We apologise in advance for the necessary reduction in social interaction that this may necessitate.
- In order to maintain social distancing initially only one patient will be allowed in the building at any time unless a parent or carer is accompanying a patient. All other family members are asked to stay in their cars or at home. This will be strictly enforced.
- The inner front door will be kept locked and patients are asked to attend at their appointment time and not earlier.
- We intend to eliminate waiting inside the practice and at reception for the time being. Appointments will initially be made with gaps between to ensure only one person is in the building at any time and that there is time between appointments for the extra cleaning required.
- When we are more practised at the flow of patients in the building then appointments will be staggered so that patients do not arrive or leave at the same time as other patients as far as we are able to manage.
- The waiting room will remain closed for the time being. The magazines and childrens toys have been removed
- Please try to keep the personal belongings that you bring with you to only the most essential and minimum.
- There is now a screen at reception to protect and socially distance receptionists and patients
- We will be operating card or bank transfer payments only for now; and we kindly request if possible that you avoid cash payments at the reception desk.
- Risk assessment of Covid-19 status: you will be asked questions relating to whether you have tested positive for coronavirus or currently have the symptoms of Covid-19 when we confirm your appointment by phone and then again as you enter the building
- The scheduling and confirmation of the appointment will be based on your ‘risk’ status and the nature of the treatment planned. If we feel there is a possibility of having been infected, even if you are asymptomatic, we will respectfully request for you to delay booking any appointments with us for 2 weeks and to follow government guidelines regarding testing and self-isolating.
- Please be sensitive to the vulnerability of others to this disease. If you have symptoms do not attend.
- Currently I am recommending that patients in the high-risk groups for developing complications from coronavirus delay any non-essential dental treatment if possible until the trend of the pandemic becomes clear.
- If you are in a high-risk group and do want an appointment or require treatment we will schedule your appointment at the beginning of the day.
- In some cases I will contact a patient prior to their appointment to assess what procedure I am likely to need to carry out and therefore its risk level to allow us to plan appropriately.
- Currently there is little evidence that temperature testing is reliable in helping to determine the status of a person as someone can have Covid-19 and not have a temperature, so temperatures will not be taken as you arrive. Someone can have a temperature due to a dental abscess.
- The staff (and myself) will complete a health risk assessment as they enter the building at the beginning of the day and will be sent home for testing if they display signs of the disease. I have a strict procedure in place to manage Covid-19 among the staff, a member of their family or for if a patient is taken ill on the premises, including notifying all possible contacts within the building from the previous 48 hours.
Hand and respiratory hygiene
- On entering the building everyone will be asked to use the alcohol hand rub in reception, there are other handrub stations throughout the building and you will be asked to use these
- You may be given a facemask to wear in the building
- Catch it, Bin it, Kill it signage is posted to remind people of the need to avoid coughing and sneezing over other people, disposal of tissues and hand cleaning after
- For the time being the toilet is to be used as little as possible and I would ask people to 'go' before they leave home. If you do need to use it please inform a member of staff first so that it can be cleaned afterwards. Please do your best to ensure that you leave the facilities as you would expect to find them and wash your hands thoroughly afterwards.
- The hand drier in the toilet is turned off and paper towel is to be used instead.
Arriving at the practice
- You will be met at the door by either me or my nurse-we will be wearing masks, visors and aprons
- You will be asked the Covid-19 risk assessment questions. If there is any suggestion that you are unwell you will be asked to leave immediately.
- If there are no concerns then you will be given a face mask to wear and then asked to clean your hands with handrub
- You will be accompanied directly to the surgery where you will be asked:
- To place your belongings in a plastic box
- Remove the mask and
- Use a virucidal pre-rinse (hypochlorous acid)
- At the end of the appointment you will be asked to replace the facemask, use the alcohol handrub, collect your belongings and accompany Penny downstairs
- Further appointments will be made and payments taken (we would prefer no cash if possible for the time being)
- You can then use the handrub again if you wish and dispose of the facemask in the bin provided
This policy will be constantly reviewed and updated as necessitated by circumstances over time. If you have any questions regarding this guidance or about your dental care, please do not hesitate to contact us on: email@example.com or call us 01603 624012
I thank you for all your patience and look forward to seeing you soon!