Protocols

  Today`s Dental @ Cayce

Todays Dental @ Cayce will be following guidelines after we reopen post the COVID19- shut down.

These procedures are created with first priority being the safety of our patients and our staff. Below are a few steps ( before, during and after ) that are being  adopted/followed in our daily routine.

 Before Dental Care Starts

1. Dental health care personnel (DHCP) experiencing influenza like illness shall not report to work. Also take a free test for COVID-19.
2. All DHCP shall self-monitor by remaining alert to any respiratory symptoms (e.g., loss of smell, loss of taste,cough, shortness of breath, sore throat) and check their temperature twice a day with the non contact thermometers. (above 100 shall not work)
3. Call the office manager, if an employee develops fever or respiratory symptoms to determine whether medical evaluation is necessary. For eg : contact your local or state health department immediately if you suspect a patient has COVID-19. 
4. Dental Assistant shall conduct a check daily on inventory of available personal protective equipment (PPE) supplies (e.g., surgical masks, surgical gowns, surgical gloves, face shields).
5. Remove magazines, reading materials, toys and other objects that may be touched by others and which are not easily disinfected.
6. Print and place signage in the dental office for instructing patients on standard recommendations for respiratory hygiene/cough etiquette and social distancing.  (ADA)
7. Schedule appointments apart enough to minimize possible contact.
8. Always have only one patient in the waiting room
9. Explaining new safety policies over phone while scheduling the appointment. Ask if the patient has any symptoms of fever, loss of smell, loss of taste,cough, shortness of breath, sore throat.
10. All supply deliveries from package carriers or dental suppliers must be accepted outside and sanitized once in practice.
11. Urgent Patients
    1. If a patient does not have a fever and is otherwise without even mild symptoms they can be seen in dental settings with appropriate protocols.
    2. If a patient has a fever strongly associated with a dental diagnosis but no other signs/symptoms of COVID-19 infection , they can be seen in dental settings with appropriate protocols, write an antibiotic and then see them later when the fever subsides.
    3. Only see around 5 hygiene patients per day (1 Patient every 90 minutes).  Have a dental assistant assigned to High Volume Suction for the hygienist to eliminate aerosol spray after the state of emergency is lifted.
    4. For dental procedures add an additional 20-30 minutes per patient, per procedure to help mitigate any contamination and allow for the best patient/team management.
12. Upon Patient Arrival
    1. Patients and/or their Parent/Guardian shall be made to fill check-In form from their car or upon arrival at the office or use the front office kiosks to fill in electronically including the No Harm form, COVID-19 declaration.
    2. The Patient and/or their Guardian/Parent will wait in the car until the office calls the  patient into the office. 
    3. The patient (if a minor, special needs patient, elderly patient) will be escorted to the office door by the parent/guardian.  
    4. Only the patient is allowed in the office.
    5. Proper Patient protection will be at the door for the patient to put on before entering the office.
    6. Protective gear, mask and gloves will be provided.
    7. The temperature of every patient will be taken before they come into the office. They shall be asked about loss of smell, loss of taste,cough, shortness of breath, sore throat.
    8. DHCP shall ensure that there are supplies always for infection control e.g., alcohol based hand rub with 60-95% alcohol, tissues, and no-touch receptacles for disposal at healthcare facility entrances, waiting rooms, and patient check-ins and make sure all commonly touched areas are regularly disinfected.

During Dental Care

1. Dental face-shields shall be used for all dental treatments. This includes hygiene and routine examinations.Face shield is used to protect mucous membranes of the eyes, nose, and mouth during procedures likely to generate splashing or spattering (large droplets) of blood or other body fluids. Face-shields are a reusable if disinfected. Wiping down with medical grade disinfectant will effectively clean the shield.
2. N 95 masks and full PPE gear must be used. These  can also be reused. The primary use of masks is to protect others (patients) from getting infected by the wearer.
3. Since SARS-CoV-2 may be vulnerable to oxidation, use 1.5% hydrogen peroxide or 0.2% povidone as a preprocedural mouth rinse.
4. Reduce aerosol production as much as possible, as the transmission of COVID-19 seems to occur via droplets or aerosol, and DHCP shall prioritize the use of hand instrumentation.
5. DHCP shall use rubber dams if an aerosol-producing procedure is being performed to help minimize aerosol or spatter.
6. DHCP shall prefer the use of high-volume evacuators. DHCP shall be aware that in certain situations, backflow could occur when using a saliva ejector, and this backflow can be a potential source of cross contamination.
7. When hygienists treat patients a gown shall be used. When a hygiene check needs to be completed by the doctor the hygienist shall do the following.

• Remove the gown and leave the gown in the room. Gown shall not be worn in common areas (common area).
• Gowns can be reused when working on the same patient.
• Doctors shall switch gowns when moving between operatories.
• Once treatments and procedures are done gowns shall be discarded.

After Dental Care Is Provided

8. Upon completion of the dental service, the patient’s guardian/parent will be notified by phone to come to the front door.
9. The Patient will use hand sanitizer when leaving the office (They use it twice; arrival and departure) if needed (they shall be wearing gloves).
10. The patient will be “Handed-off” to their parent/Guardian who is outside by the door and NOT in the office
11. If a payment is required, the patient will be required to make the payment before leaving the office
12. A follow up appointment will be given at the time of payment.
13. Patient will discard all protective equipment in the designated area.

At the End of Day

14. Please remove the disposable lab coat before you remove your gloves.
15. If desired, please bring a change of clothing to change into and properly store your garments in a plastic bag so you can wash when you return home.
16. After that wash your hand with soap and water for at least 45 second.
17. After each visit every place the patient goes shall be wiped down with Cavicide or an equivalent surface disinfectant.
18. If a follow up appointment was not made please make an appointment over the phone while the patient or guardian/parent is in their car.

ADA Interim Mask and Face Shield Guidelines

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