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Covid-19 Protocol

APPLE DENTAL OFFICE PROTOCOL During COVID-PANDEMIC

STAFF - If you exhibit symptoms of COVID at any time during your workday you will perform hand hygiene, don a mask, perform hand hygiene, proceed to your dentist and tell them you have presented with symptoms and then will proceed home (a safe mode of travel will be determined depending on your symptoms). You will update the dentist when you get home and daily afterwards. Team members will be pre-screened prior to the start of their work day using the Dental Office Staff Daily Screening Form. This will be recorded and kept in a binder. (Staff work consent form).

Disinfection of operatories will follow accepted protocol using Sterile wipes. Sterilization of instruments will be carried out as per Standard Operating procedures or Statim for the instrumentation as required.

Respiratory hygiene includes wearing a mask when physical distancing is not possible. Utilizing physical distancing when it is possible. 

Only 1 receptionist at a time. Do not share lunch room, lab or sterilization area

When receiving deliveries, team members must wear gloves and masks when collecting and / or accepting parcels and disinfect the parcels and surfaces they contact.

Establish and maintain a contact register for all people entering the practice including date and time of entry and exit, and the person’s phone and email details, to facilitate contact tracing by BCCDC if necessary.

Team members must wash or disinfect hands thoroughly; before and after any contact with patients; after contact with contaminated surfaces or equipment; after removing PPE; following established PPE protocols. Hand hygiene is one of the most effective ways to prevent disease spread. For further clarity hand hygiene must be performed:

-when in the patient care environment

-before and after direct contact with a patient

-before and after 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 laboratory materials or equipment and when hands are visibly soiled.  DO NOT TOUCH FACE OR MASK !

Team members must not wear scrubs to / from work. Work shoes advised.

Movement between the clinical area and the front office should be minimized.

 

PATIENT ARRIVAL

Patients should be advised to telephone the clinic from outside upon arrival. Patients should wait in their vehicle or outside the clinic until called upon to enter the premises.

Patients must attend their appointments alone unless circumstances require assistance (eg. child) at which point one other guest may attend. All patients and guests can be encouraged to enter the clinic wearing a community mask.

Check in station will include: hand sanitizer, screening forms with clipboard, pen, steri-wipes to sanitize pens and clipboard.

Patient will be greeted on entry by staff who are wearing a mask, eye protection and gloves.

Patients and guests must sanitize hands immediately upon entering the clinic. Patients and any accompanying guests must be screened for signs and symptoms of COVID-19 during patient check-in and shall not be allowed further entry if signs and symptoms are present. 

Temperatures must be taken and recorded, and patients with temperatures exceeding 38C must not be seen unless the patient’s fever can reasonably be attributed to a dental issue (pulpal / peri-apical dental pain and intraoral swelling). If screening reveals signs or symptoms of Covid-19, the appointment must be deferred for a minimum of 14 days, and the patient must be advised to call Tele-Care 811. 

After check-in, patient should be seated in operatory and patient traffic flow must be reduced to a capacity that ensures strict adherence to physical distancing guidelines. 

Staff should accompany patient throughout the clinic to minimize touching of surfaces.

Patient will not enter the facility until their operatory and treatment team is ready for them, unless they arrived in taxi or their ride has to drop them off and leave, and the weather outside is inclement or exceedingly hot and patient is elderly.

 

DURING DENTAL CARE

Patients should rinse with antiseptic mouthwash (1% hydrogen peroxide) for 30-60 seconds before any procedure.

Use of air / water syringe should be minimized.

The high-volume evacuators should be used primarily.

 

PROTOCOL FOR HIGH RISK AEROSOL GENERATING PROCEDURES

(Aerosol generating instruments - Use of all rotary handpieces, ultrasonic and

sonic scalers, triplex syringe, air-abrasion and air-polishing must be kept to a minimum. Use high volume suction in all aerosol procedures.

High volume suction reduces aerosols by 95%.

The majority of exposures are preventable by following routine procedures. Where there is low incidence and prevalence of COVID-19, additional PPE

​over and above that required for normal precautions is not required.

 

PATIENT DISMISSAL

Appropriate PPE should be worn for cleaning operatories. At minimum wear a gown, gloves, surgical mask and protective eyewear.

Patients can put on their community mask if they have one.

Patients should make payments using debit, e-transfer or credit cards and arrange pre-payment so they can leave immediately.

Promotional items such as toothbrushes, floss, appointment cards, children's toys, etc. should not be provided.

Patients and guests must sanitize / wash hands immediately before exiting the clinic. They then should leave directly.

Post operative care will be administered via telephone when possible.

 

SANITIZATION

Disinfect debit machines after each use. Cover keyboards.

Clean and disinfect touch surfaces and common areas throughout the office frequently (minimum 2x/day).

Regularly disinfect reception desk, including transparent barrier if present.

 

END OF DAY

Thoroughly clean and disinfect all surfaces, including floors.

Dispose of all used PPE using standard waste procedure.

Staff must change from scrubs (mandatory) and work shoes (if possible) into personal clothing before leaving the clinic.

Dentist notes are to include who assisted, and who was working.

 

EXTERNAL SERVICE PROVIDERS AND DELIVERY PERSONAL

External service providers (including delivery personnel, lab personnel, and contractors) should be screened for signs and symptoms of COVID-19 at every visit. If signs or symptoms are present they should not enter.

External service providers should be leaving deliveries at the door.

When entering, perform hand hygiene and put on a mask if a 2-metre distance from staff and patients cannot be ensured.

All staff and external service providers are logged at entry to the facility.

  

        RECEPTION:    AT THE TIME OF BOOKING AN APPOINTMENT

            PRESCREENING of COVID symptoms at time of booking

Advise the patient of what to expect on arrival at their appointment:

-patient to remain in vehicle and call or text upon arrival.

-nobody is to accompany the patient (unless required)(child, elderly, debilitated)

-encourage patient to wear a mask of their own to the clinic

-greeting at door, and another screening (temperature) about COVID

 -Hands will be sanitized -  this is mandatory.

-ask them to be prepared to pay with credit/debit to limit cash transactions

Ask of the patient:

1. Do you have any of the following symptoms: fever, new or worsening cough, sore throat, headache, sneezing, loss of smell, or runny nose?

If you answered YES, and have symptoms that cannot be explained by allergies or non flu like causes, then re-book in 14 days.

If you answered YES, and have 2 or more of the symptoms, then advise to self-isolate at home, and call 811.

2. If you answer  YES to any of the following below, then you must stay home and can reappoint in 14 days.

 a. Have you had close contact within the last 14 days with a confirmed case   of COVID19?

 b. Have you had close contact within the last 14 days with a person being tested for COVID-19?

 c. You have been diagnosed with COVID-19 or are waiting to hear the results of a lab test for COVID-19.

 d. Have you returned from travel outside of British Columbia within the last 14 days?

 e. Have you been told by public health that you may have been exposed to COVID-19 

Determine if the patient is high risk - do they have any of the following:

-Heart disease /-Diabetes /-Immune-compromised /-Severe respiratory illness (moderate to severe asthma) /-Over 70years old /-Chronic kidney disease 

/- Dialysis /- Liver disease /- Pregnant

 

AT THE TIME OF BOOKING AN APPOINTMENT  –  Arrange Pre-Payment

Let the patient know that they must read and respond to the patient consent form for a dental appointment and treatment. Email back or bring signed form.

They will be asked the same questions again on their arrival when they phone us from their vehicle.

They should be advised to take their own temperature just prior to arriving for an appointment as we will take their temperature at the door and if it is above 37.5 then we will have to rebook them in 14 days. That is the College and Health BC regulation.