COVID-19 SAFETY PROTOCOL
About COVID-19
Coronaviruses are a large family of viruses found mostly in animals. In humans, they can cause diseases ranging from the common cold to more severe diseases, such as Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS). The disease caused by this new coronavirus, SARS-CoV-2, has been named COVID-19. While many of the characteristics of COVID-19 are still unknown, mild to severe illness has been reported for confirmed cases. Transmission COVID-19 is most commonly transmitted through large droplets produced when a person infected with COVID-19 coughs or sneezes.
The virus in these droplets can enter through the eyes, nose or mouth of another person if they are in close contact with the person who coughed or sneezed. The virus can also enter a person’s body from touching something with the virus on it and then touching one’s eyes, mouth or nose with unwashed hands. The incubation is on average 5-6 days, but can be up to 14 days with or without symptoms.
Transmission from a pre-symptomatic person can occur before onset of symptoms. Pre-screening protocols Screening for risk factors and symptoms of COVID 19 prior to attendance at the practice must be provided for all patients. If screening reveals risk factors or symptoms of COVID 19, defer patient (where reasonable) until signs and symptoms have resolved.
Pre-screening includes asking patients if they have symptoms of COVID 19:
-cough
-sore throat
-shortness of breath
-runny nose, sneezing, post-nasal drip, loss of smell, with or without fever
-If they have had close contact or have been in isolation with a suspected case in the last 14 days
-If they have travelled internationally in the last 14 days
If the answer to any question is positive, the patient needs to be rescheduled and/or managed by phone.
When the patient arrives for their appointment, their pre-screening responses must be confirmed and recorded in their record.
Day-of-appointment screening
-review screening questions
-take patient temperature
-when speaking to patients ask them to:
-reschedule if they become sick, are self-isolating, or have travelled outside the country within the last 14 days
-attend appointments alone when possible
-patients to complete paperwork prior to their appointment when possible
-on-site administrative staff who are screening patients must be behind a transparent barrier, or wearing PPE High Risk Patients
Patients most susceptible to severe COVID 19:
- serious respiratory disease
-serious heart conditions
-immunocompromised conditions
-severe obesity
-kidney/liver disease
-pregnant patients
-patients 70yrs and over
These patients should be screened carefully to determine urgency of dental need and risk of receiving treatment
Patient Requirements -before entering
- perform hand hygiene and put on mask
-patient advocates
- wait outside or return to pick up patient
-Staggered patient appointments
- 30 minutes between appointments
-Patients to arrive only 5 minutes before appointment time (unless more time is required)
-patients brought into treatment room immediately
-no patients in the waiting room
TEAM MEMBER SAFETY
-staff ill, or with an unprotected exposure to someone with confirmed COVID 19 are required to self isolate
-staff with any signs or symptoms consistent with COVID 19, should be tested for COVID 19 and excluded from work
-prior to every shift, team members are required to report if they have had potential unprotected exposure to COVID 19 and make an entry into the Daily Log Book
-if a staff member develops signs or symptoms of COVID 19 at work they should immediately perform hand hygiene, keep mask ON, inform Dr P, Dr Jan, or Dr Warren, avoid further patient contact, and prepare to go home AGMP
- Aerosol-generating medical procedure
Minimum PPE required For Non-AGMP:
For AGMP:
-Surgical mask
-N95 mask
-Eye protection
-Eye protection
-Safety glasses
-Face shield over:
-Prescription glasses
-Safety glasses
-Prescription glasses
-Gloves
-Gloves
-Long sleeve gowns
PPE should be removed in the following order: gloves, gown, protective eyewear, mask.
Perform hand hygiene immediately after -if possible, change into street clothes before leaving work, place scrubs in bag, scrubs should be laundered daily. Shower immediately upon returning home after your shift.
-maintain physical distance from coworkers as best possible
When masks and face shields are applied for the full duration of shifts:
-perform hand hygiene before putting on mask and face shield
-wear mask securely over mouth and nose
-do NOT touch mask or face shield
-reusable shields need to be properly cleaned
-perform hand hygiene before and after PPE removal and between patients
Personal PPE for patients
-routine protective measures including bibs, drapes, and eye protection
Managing droplet and spatter
-high volume suction must be used to reduce aerosols at source
-rubber dam should be used wherever possible
-unnecessary equipment and items must be removed from the operatory
-countertops and touch surfaces should be cleared wherever possible
-use of all rotary handpieces which generate aerosols, regardless of weather air driven or electric (with or without water) and other instruments such as ultrasonic and sonic scalers, triplex syringes, air-abrasion and air-polishing must be kept to a minimum
Standard precautions
- same practices
Hand hygiene
-when in the patient care environment
-before & after direct contact with a patient
-before procedures
-after risk of body fluid exposure
-before donning gloves and immediately after removing gloves
-before and after mask use
-after contact with environmental surfaces
-after contact with dental lab materials or equipment and when hands are visible soiled
Office Cleaning Clinical area:
-all contacted surface must be cleaned between patients and at the end of the day
-appropriate PPE should be worn for cleaning operatories
-at minimum wear gown, gloves, surgical mask, protective eyewear
-a fresh gown is needed for cleaning
-wipe down hard surfaces using a two-step process
-first with detergent and water, then hospital grade disinfectant Reception/waiting area:
-remove all unnecessary items from the waiting room
-clean surfaces with ready detergent wipes
-clear signage for patients to view protocols
Deliveries / Service providers
-leave all deliveries at the door
-before entering
- perform hand hygiene and put on mask
-all staff and external service providers are logged at entry to the facility
Note: BCCDC’s authoritative guidance with respect to the use of N95 masks: these are only required for aerosol generating medical procedures with patients with suspected or confirmed COVID-19.