Since the disruption of the COVID-19 pandemic to the dental industry, there is a vast amount of information circulating on infection control, personal protective equipment, and other dental supplies. Unfortunately, not all is accurate, and that information has the potential to jeopardize not only your practice but the safety of your team and patients.
To avoid falling prey to any of the myths and missteps in infection control and the appropriate use of PPE, here is a guideline for a safe and reliable practice during this pandemic.
1. Maximizing PPE Use for Your Practice
PPE use is part of a protection of workers in the dental setting. But wearing it is not enough. Knowing the appropriate use of PPE provides a safe workspace, and safety for you and your team.
Here are some of the tips and information that your team needs to know about the different types of PPE.
Face shield and goggles
The Centers for Disease Control and Prevention (CDC) and Occupational Safety and Health Administration (OSHA) deem goggles and face shields suitable to protect the wearer’s eyes against exposure to the SARS-CoV2 virus. The mucous membrane of the eye can serve as an entry for aerosols and splatters. Prescription glasses and trauma glasses are not considered protective eyewear for the dental setting when performing aerosol generating procedures (AGP), or caring for patients who may have been infected with COVID-19. These glasses do not offer the same degree of protection as goggles and face shields. It is also important to note that eye protection must not interfere with the fit of a respirator.
Masks and respirators
Face masks and respirators are integral to protect you from aerosols and splatters. However, cloth face coverings are not considered as PPE, and do not serve as substitutes to respirators or face masks.
In some states, OSHA does not acknowledge foreign-made respirators. The N95 respirator or higher should be utilized in dental settings when performing AGP, or when caring for a patient with COVID. A respirator providing a tight fit offers a higher level of protection because it filters all of the inhaled air of airborne contaminants.
Below is helpful information on respirators:
- The first choice should be a respirator approved by National Institute for Occupational Safety and Health, referred to as NIOSH-certified N95 respirators.
- Disposable filtering facepiece respirators, elastomeric respirators, powered air-purifying respirators (PAPRs) are examples of respirators that can be utilized in healthcare.
- N95 respirators with an exhalation valve should not be used when performing sterile/surgical procedures because unfiltered air escapes from the valve onto the sterile field. This may include procedures such as periodontal surgery, implant placement, biopsies, surgical extractions, etc. If you must use the mask for these types of procedures, cover the respirator with a surgical mask that does not interfere with the fit of the respirator. Since the unfiltered air escapes from the valve, these respirators should not be used for source control.
- Buy respirators only from reliable sources to avoid counterfeit products.
- The filtering face piece respirator has no markings.
- The headband or the filtering face piece respirator has no approval (TC) number.
- There are no NIOSH stampings or NIOSH is misspelled.
- Embellishes, decors on fabric, or other add-ons like sequins are present.
- Claims for children’s use (NIOSH does not approve any respiratory protection for children) .
- Use of ear loops instead of headbands on the filtering facepiece may be on approved KN95 masks, but are not incorporated in N-95 masks.
Donning the Respirator
- Prior to wearing a respirator, a complete respiratory protection program must be implemented within the dental facility. This program must be written and include the following elements: training, appointing an administrator, medical clearance, fit testing, seal check, and recordkeeping.
- Because breathing can be more difficult in a respirator, a medical clearance evaluation must be performed before fit testing. Some medical conditions ( ie. heart conditions, lung disease, and certain psychological conditions, and others) may prevent the wearing of a respirator. This evaluation should be performed by a licensed healthcare professional. OSHA requires that employers provide these evaluations free of charge to all workers who are required to wear respirators on the job.
When donning a respirator, perform an initial fit test following the OSHA-Accepted Fit Test Protocols. Note that OSHA requires an initial fit test for each make, model, style and size of respirator. However, OSHA has waived the annual fit test requirement at this time.
- Conduct a seal check each time you don an N95 respirator. A seal check ensures that there is a tight seal between the face and the respirator ensuring that inhaled air is being filtered. Air should not escape around the mask when performing a seal check. If air leaks between face and face seal, reposition and readjust for a more secure seal. Note that a seal check is not a substitute for fit testing noted above.
Use of Personal Protective Equipment (PPE)
Clinical jackets and gowns
A full gown offers more overall protection from aerosol-generating procedures than that of a clinical jacket, which usually reaches only to the hip level.
In handling all types of PPE, you need to take note of the following reminders:
- Wear the complete set of PPE based on the task and risk of exposure. During this pandemic, gown, gloves, eye protection (face shield/goggles) and respiratory protection should be worn for all patients. When performing aerosol generating procedures, an N95 respirator or higher should replace a surgical mask. PPE should be donned before entering the operatory or care area.
- Remove the gown/jacket and gloves in the operatory or care area. Eye and respiratory protection should be removed, after exiting the care area. The CDC provides directions on this process.
- Discard single–use products and clean and disinfect reusable PPE based on the manufacturer’s instructions for use.
- Always perform proper hand hygiene after removing or discarding any PPE.
2. Appropriate Use of Surface Disinfectants
Here are a few reminders on disinfectants to ensure the safety of you and your patient:
First identify clinical contact surfaces vs. housekeeping surfaces within your facility. Clinical contact surfaces have a high potential for direct contamination as they come into direct contamination from hands, instruments, gloves, devices. Examples include light handles, bracket trays, switches on dental units and others. Housekeeping surfaces pose a limited risk of disease transmission as they do not come into contact with patients or devices. The surfaces include floors, walls, sinks, break areas, reception room and non-patient areas.
- For clinical contact surfaces, clean and disinfect using an EPA-registered hospital-grade disinfectant that is included on EPA List N. The EPA expects all products on List N to kill the coronavirus SARS-CoV-2 (COVID-19) when used according to the label directions.
- Do not use 2X2 or 4X4 and soak them into liquid disinfectant. This reduces the effectiveness of the solution, and the components of the gauze can deactivate the disinfectant.
- Housekeeping surfaces may be cleaned and disinfected with household products such as disinfectant wipes. Follow manufacturer instructions. Note that household products may be used on housekeeping surfaces within the dental facility (door knobs, floors, reception area), but NOT on clinical contact surfaces.
Today and moving forward
The COVID-19 may have presented a great challenge to the dental industry. But with the right sources, equipment, and protocols, the dental world will continue to serve its patients.
Whatever we are working on today and what we did yesterday on infection control, we fine-tune that today and ensure our protocols are relevant. Tomorrow, we may find that things loosen up, or they may be just as rigorous as today. But the proper application of infection control in your practice will guarantee the safety and reliability of your team and your patients.
There is an available wealth of resources for keeping your practice safe and COVID-free. Here are the relevant websites you should visit on a regular basis:
Centers for Disease Control and Prevention (CDC)
CDC has the most current version for interim Infection Control guidance during the COVID-19. The guideline was updated on August 28, 2020.
Organization for Safety, Asepsis, and Prevention (OSAP)
OSAP is dentistry’s only membership association solely dedicated to infection prevention education. To better implement all the latest interim guidance and regulations, download their complimentary Best Practices for Infection Control in Dental Clinics During the COVID-19 Pandemic. This “living” document is updated whenever interim guidance is changed. For information on membership, visit https://www.osap.org/page/Membership.
Occupational Safety and Health Administration (OSHA)
OSHA has regarded dental professionals as very high risk for exposure to COVID-19. Hence, they published a COVID-19 guide for every business and their workers who may have potential exposures to SARS-CoV-2.
American Dental Association (ADA)
ADA has a resource page of COVID-19 that was updated multiple times to present some of the infection control changes. Tools and checklists are available to ensure full compliance with infection control protocols, as recommended by the CDC.
California Dental Association (CDA)
For those in California, the California Dental Association has in-depth resources aligned with the California regulations. This site has a back-to-practice feature that includes useful information to ensure compliance with infection control and safety.
Given the ever-evolving nature of the research being made on COVID-19, please make sure to check these sources frequently. You may also visit the Benco Learning Center for the latest articles and webinars on dental practices and related matters.