ADHA Interim Guidance & A Review of Air Purification Systems David Reznik, DDS Gary Severance, DDS Director of the Oral Health Center of Executive Leader of Professional Grady Health System’s Infectious Relations, Henry Schein Dental Disease Program
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CDC’s Summary of COVID -19 Activity Nationally, levels of influenza-like illness (ILI) and COVID-19-like illness • (CLI) and the percentage of specimens testing positive for SARS-CoV-2, the virus that causes COVID-19, continue to decline or remain stable Mortality attributed to COVID-19 also decreased compared to last week • but remains elevated above baseline and may increase as additional death certificates are processed
CDC’s Summary of COVID -19 Activity The national percentage of respiratory specimens testing positive for • SARS-CoV-2 at public health, clinical, and commercial laboratories decreased from week 20 to week 21 National percentages by type of laboratory: • ❖ Public health laboratories – decreased from 8.4% during week 20 to 7.0% during week 21 ❖ Clinical laboratories – decreased from 6.3% during week 20 to 5.6% during week 21 ❖ Commercial laboratories – decreased from 7.8 % during week 20 to 6.9% during week 21
CDC’s Summary of COVID -19: Key Points The percent positivity increased slightly in two HHS surveillance regions: ❖ Region 4 = the southeast ❖ Region 10 = the Pacific northwest
If your community is experiencing no transmission or minimal community transmission • Dental care can be provided to patients without suspected or confirmed COVID-19 using strict adherence to Standard Precautions • Given that patients may be able to spread the virus while pre- symptomatic or asymptomatic, it is recommended that DHCP practice enhanced IC whenever feasible ❖ “No to minimal community transmission” is defined as evidence of isolated cases or limited community transmission, case investigations underway; no evidence of exposure in large communal setting
If your community is experiencing minimal to moderate or substantial transmission • Dental care can be provided to patients without suspected or confirmed COVID-19 using considerations to protect both DHCP and patients and prevent the spread of COVID-19 in dental facilities ❖ Minimal to moderate community transmission is defined as sustained transmission with high likelihood or confirmed exposure within communal settings and potential for rapid increase in cases ❖ Substantial community transmission is defined as large scale community transmission, including communal settings (e.g., schools, workplaces)
CDC’s Summary of COVID -19: Key Points The overall cumulative COVID-19 associated hospitalization rate is 73.3 • per 100,000, with the highest rates in people 65 years of age and older (229.7 per 100,000) followed by people 50-64 years (113.4 per 100,000) Non-Hispanic Black and non-Hispanic American Indian/Alaska Native • populations have rates approximately 4.5 times that of non-Hispanic Whites Hispanic/Latinos have a rate approximately 3.5 times that of • non-Hispanic Whites
Hospitalization Rates Based on Age Age Group Cumulative Rate per 100,000 Population Overall 73.3 0-4 years 4.1 5-17 years 1.9 18-49 years 41.0 18-29 years 20.1 30-39 years 40.7 40-49 years 68.5 50-64 years 113.4 65+ years 229.7 65-74 years 167.6 75-84 years 276.2 85+ years 426.7
ADHA Interim Guidance on Returning to Work
ADHA Interim Guidance on Returning to Work “In order to protect the dental hygienist, the dental team and patients, the American Dental Hygienists’ Association (ADHA) continues to support the recommendations from the Centers for Disease Control and Prevention (CDC) that balance the need to provide necessary services while minimizing risk to patients and dental healthcare personnel (DHCP). The following considerations have been prepared utilizing guidelines, regulations and resources from key resources including, but not limited to, CDC, the Occupational Safety and Health Administration (OSHA), the American Dental Association (ADA) and the Organization for Safety, Asepsis and Prevention (OSAP).”
ADHA Interim Guidance on Returning to Work Prior to returning to work, all dental team members should be tested for • COVID-19, where feasible, subject to state and local regulations Individuals who test positive or present with symptoms should not report • to work and should follow quarantine protocols If there is a surge in incidence of COVID-19, consider providing • emergency services only Continually monitor risk level incidence, as there may be times when it • will be important to cease nonessential procedures if there is a surge in COVID-19 incidence
Communication with Your Team Meet with your employer and the entire dental team to have an open conversation about: Current supply of PPE and new supplies needed • Screening practice for COVID-19 • Methods to reduce/eliminate aerosol production in the office • Strategies for social distancing among patients and the dental team • Scheduling changes for providers to allow for appropriate disinfecting between • patients Identify one team member who will regularly monitor national resources and update the entire dental team on key recommendations that will impact practice, including ADHA’s COVID -19 Resource Center.
Patient Preparation Using the telephone or Teledentistry, screen all patients for symptoms • consistent with COVID-19; if the patient reports symptoms of COVID-19, avoid non-emergent dental care ❖ If possible, delay dental care until the patient has recovered ** Pre-screening of patients, using Teledentistry, will reduce the number of • in-office patients, as well as post-treatment follow-up appointments If forms need to be completed and signed, provide pens to the patients, • and instruct them to keep the pens for their personal use
Special Considerations for Providing Dental Hygiene Care High-volume evacuators (HVE) should be available in dental hygiene • rooms, and a dental hygiene assistant should be available during procedures that require HVE Use hand instrumentation versus ultrasonic instruments for periodontal • debridement and scaling procedures Use selective plaque and stain removal versus full-mouth coronal • polishing Avoid air-polishing procedures • Do not use the air and water functions on the syringe, together, at the • same time
Fit-Testing N95 Facial Respirators OSHA requires initial fit testing for new employees; best practice for • respiratory protection involves the use of N95 respirators custom-fitted for critical tasks Training on fit and seal should be provided prior to use; other masks may • be used for non-critical tasks Remove the respirator after every patient •
Fit-Testing N95 Facial Respirators Fit-test kits are available commercially -- carefully follow manufacturer • instructions; respiratory fit testing: ❖ can be done by employer or outside party ❖ should be done annually thereafter ❖ uses an agent to check whether there is leakage around the respirator Remove and discard disposable respirators and surgical masks • ❖ Perform hand hygiene after removing the respirator or face mask – Resources: • CDC Illustration of COVID-19 PPE for Health Care Personnel • Hospital Respiratory Protection Program Toolkit: Though designed for hospitals, the information in this resource from the Occupational Safety and Health Administration (OSHA) can be customized for your practice
OSHA Recommendations on N95 Reuse or Past Shelf Life When alternatives are not available, or where their use creates additional safety or health hazards, employers may consider the extended use or reuse of N95 FFRs, or use of N95 FFRs that were approved but have since passed the manufacturer’s recommended shelf life, under specified conditions.
OSHA Recommendations on N95 Reuse or Past Shelf Life NIOSH has tested a sample of N95 FFRs that are beyond their manufacturer’s recommended shelf life from facilities across the United States and determined that certain N95 models continue to protect against the hazards for which they would ordinarily be appropriate. (for N95 FFRs, this means they are still expected to filter out 95% of particles of the most penetrating particle size, or 0.3 µm)
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