Covid-19 Patient Information

Main

June 02

COVID-19 Patient Information

Introduction:
This document outlines the modifications that we are required to make to our normal procedures once the practice is re-opened following the current stage of COVID-19 outbreak. Our #10 point back to safe dental treatment policy is based on the best available current scientific evidence and has been formulated in consultation with a wide variety of dental professionals and organizations.
This policy will be updated and modified as we gain more scientific evidence as to the most appropriate treatment protocols, and to ensure that we offer the highest standard of SAFETY 1st FOR OUR PATIENTS & THE TEAM procedures in line with the recommendations and guidance published by the Department of Health.


SAFETY 1st FOR OUR PATIENTS AND THE TEAM :


We have evaluated the scientific evidence and official advice and modified the way in which we deliver treatment in view of the lessons we have learned from COVID-19. The measures that we have put in place are practically designed to significantly reduce the risks of transmission to our staff and our patients, making use of the best practice guidelines and equipment.
The aim of this policy is to ensure the continued safety of our staff and all of our patients and we would like your full cooperation in this matter.

POINT #1 How safe are we?
Scientific evidence has proven that dental practices have been at the forefront of prevention of cross-infection and spread of microorganisms and viruses (such as the AIDS and Hepatitis viruses) for years, employing the latest techniques, and procedures in specially designated cross infection, decontamination and sterilization rooms to ensure highest levels of patient and team safety. We believe that dental practices are some of the safest places to be in during the current outbreak as we are well positioned to counter-act the corona virus and prevent its spread to our staff and our patients through our highly developed and audited decontamination measures at our practices. We review and audit our cross-infection and decontamination procedures regularly which are examined by the CQC and use specialized equipment such as vacuum autoclaves, medical washer disinfectants and ultra-sonic instrument decontamination techniques. The sterilization cycles are electronically recorded and audited regularly.
Where appropriate we use UVC light disinfection within our surgeries. Where appropriate our surgeries are fitted with air filtration to the medical isolation room standards using negative air pressure when appropriate to reduce the risk of aerosol contamination. Currently we have a dedicated waiting room for our more vulnerable patients to use during their visit away from the main waiting room. Please discuss this with our team before arriving, if you are in a vulnerable group.


We have a dedicated environmental decontamination officer whose job is to look after all decontamination procedures and anti-viral measures, at regular intervals, throughout the day.
We will be carrying out daily staff monitoring and health checks to detect early signs of any possible corona virus infection amongst the team members. Staff will be asked to take their own temperature before setting off to work each day.
Moreover, we have categorized dental procedures (e.g. Aerosol Generating Procedures AGP; non-aerosol producing treatments) and use appropriate PPE accordingly. Invasive surgical procedures are carried out in a room where the patients and the team are gowned with surgical attire to reduce the risk of cross-infection.


POINT #2 Pre-appointment Screening and Patient Communication

We have identified the need to fully communicate our new policy and extra procedures to our patients, to ensure full compliance, before their arrival for their treatment. We will be using, where possible, e-forms rather than paper forms and ask patients to pay by contactless cards or BACS payments where possible. Pre-appointment health screening questionnaire and medical forms will be requested and checked before arrival on the day. By screening the patient’s general well being, their medical condition we determine a risk profile and vulnerability and schedule appointments accordingly to reduce the risk of possible Covid-19 infectious disease spread. Obviously, safety cannot be absolute and the risk cannot be eliminated 100%. However by putting in place, an evidence-based, robust multi-layered risk management strategy that makes use of the latest technology of air purification and disinfection systems as well as use of the up to date PPE, we are certain that we are in a position to offer one of the safest environments for treatment.


POINT #3 Staggering appointments

Whenever possible, the appointments will be staggered and prolonged to allow time for these extra measures between cases. We thank you for your understanding and cooperation in these difficult times.


POINT #4 Arrival at the practice and the Check-in Process
To observe the social distancing rules, we will be reducing the number of patients in the waiting room, and so where possible appointments will be staggered.
The seating will be arranged according to social distancing rules so please respect as much as possible the personal exclusion zone. At certain times, we may ask you to wait outside or in your car, and we will call you by phone when we are ready for you to enter the reception area.


POINT #5 Restricted Practice Entry

Entry to the practice will be restricted to essential staff only. We have developed an open delivery policy for deliveries from the suppliers and dental laboratories. We would like to ask you to attend on your own whenever possible.


POINT #6 Removal of non-essential staff and clutter of equipment

We have carried out an audit of our facilities and removed all non-essential clutter and equipment. Unfortunately, this also include the removal of tea and coffee making and reading material such as newspapers from the waiting room.
All deliveries to the practice from suppliers and dental laboratories will be collected outside the building and will be cleaned with disinfectants before bringing any such items into the practice.


POINT #7 Identify Risk Categories and contain Aerosol Generating Procedures (AGP)
We have categorized the dental treatment to aerosol producing vs non-aerosol producing procedures and put in place additional measures when AGPs are carried out. Similarly patient’s treatment needs and vulnerability have been categorized in order to deliver treatments in the safest and most efficient manner.


POINT #8 New Role: Environmental Decontamination Officer

As we have stated we have a dedicated an environmental decontamination officer whose job is to look after all decontamination procedures and anti-viral measures, at regular intervals, throughout the day and work closely with our decontamination lead.


POINT #9 Second Preop Screening and preparation for treatment

When you arrive you will be greeted by one of our reception staff and be given a mask to wear which you must dispose of in the bins provided when leaving. There will be hand sanitizers at the reception area. Whenever possible we would advise the use of contactless electronic forms and pre-payment by BACS/online banking. However, our credit card terminals will be disinfected after each use at the reception.


You will be taken to the treatment room where we would help you to place your overcoat or jacket into a plastic container where it will be kept during your treatment.


Before your treatment you will be given a disposable bib, goggles and asked to rinse your mouth with hydrogen peroxide, iodine or hypochlorous (HOCL) mouth wash for 1 minute. If necessary, a nasal swab disinfectant might also be used.
During your treatment we will wear the necessary PPE which will vary slightly depending on the type of AGP or non-AGP procedure you will require. For most non-AGP treatment we will wear a surgical mask, our usual scrubs and goggles/glasses. For AGP procedures we may don a disposable gown and a filtered mask (known as FFP2 or FFP3 or N95). We may also wear a face shield over our masks.


The treatment room may be equipped with medical isolation room air filtration units which unfortunately could give higher background noise produced by the high volume extractor fan. We apologise for this and thank you for your understanding in these unprecedented times.
In some cases, we may choose to use an extra-oral air evacuation hose near the operating field to capture reduce the percentage of aerosols/ droplets produced during the treatment. This may be supplemented with use of rubber dam or mouth shield.


After the completion of your treatment you will be asked to wash your hands, put your mask on and leave the room to put your jacket or overcoat on (outside the treatment room).
Please read this document and kindly observe the necessary protocols we put in place in order to keep the safety at its highest level.


POINT #10 Decontamination and cleaning of the room and the instruments after your treatment
Current evidence shows that Covid-19 and similar pathogens can stay in the room after and AGP procedure at least up to 1 hour. Therefore, time will be taken to allow the filtration of the air in the treatment room and disinfection procedures. We step up the rate of air changes, using our air purification equipment in order to capture and kill any viruses in the atmosphere. We also use additional multi-layered virus control measures including powerful germicidal ultraviolet light (UVGI) and Hypochlorous steamers for air and surface disinfection. The room is decontaminated by a member of staff who dons the required disposable PPE.
When:
Patients that are currently under treatment, which has been delayed or postponed, will be prioritised for the first three months.


Before your appointment:
• You will be asked to fill in and sign a new medical history, it would be ideal if you could fill this form (no earlier than 3 days before your appointment) and send it to back by email.
o The form can be found attached.
• You will be asked to fill in and sign a COVID-19 assessment form, it would be ideal if you could fill this form in and send it to us prior to your appointment.
o The form can be found attached.
o If you have any COVID-19 symptoms we will ask you to delay treatment by 4 weeks.
• If you are in a high-risk group, unless your treatment is urgent, we recommend you delay treatment until the government advise that it is safe for you to attend.
o More information on whether you are in a high-risk group may be found at
https://www.nhs.uk/conditions/coronavirus-covid-19/people-at-higher-risk-from- coronavirus/
• We would advise that you pay our fees with contactless card payments, or if you know the cost of your treatment, by BACS transfer prior to your appointment.
• Please carry hand sanitizer with you at all times, use regularly and avoid touching your face, mouth and nose. Please wash your hands thoroughly at every opportunity. Wearing a face mask or a cover has been shown to be effective in public.
On Arrival at the Practice:
• To observe the social distancing rules, we will need to reduce the number of patients in the waiting room, and so where possible appointments will be staggered.
• The seating will be arranged according to social distancing rules so please respect as much as possible the personal exclusion zone.
• At certain times, we may ask you to wait outside or in your car, and we will call you by phone when we are ready for you to enter the reception area. Please ensure that all your contact details are accurate on the attached medical history form.
• When you attend the practice your temperature may be assessed, and if your temperature were to be elevated you will be asked to return home and self-isolate. You may monitor your temperature at home, before travelling for your appointment, and let us know if you think it may be above the normal.
In the Surgery:
• We will ask you to wash your hands.
• Carry out an antiseptic mouth wash (e.g. Hydrogen peroxide, HOCL or povidone-iodine gargle) and maybe use a dilute (0.5%) aqueous povidone-iodine nasal swab. This has been shown to rapidly kill the virus and reduce any viral load even if you are asymptomatically infected. Our clinical staff will be carrying out the same process regularly.
o If you have any concerns or allergies regarding Iodine or similar products such as Corsodyl please let us know.
• For procedures that involve the use of the dental drill, scaling equipment or anything which involves generating an aerosol (APG) we will wear an appropriate special mask and PPE visor. We also may wear a gown and hat when necessary.
After your appointment:
• We may recommend that future appointments are made by telephone or email, to avoid patients staying in the waiting room longer following their treatment.
• You will be asked to pay using contactless CC or by BACS
What will we be doing:
• Unfortunately, all water, tea/coffee-making facilitates will be removed and there will not be any reading materials, newspapers or magazines at the waiting room.
• We have removed all non-essential items so that we can effectively disinfect all surfaces. So, forgive us if the practice looks sparse.
• We will be continuously wiping the door handles and surfaces with appropriate anti-viral agents such as hypochlorous and use steamers or air misting equipment. This kills the virus.
• Increasing the time we allow for each appointment. This to try to avoid patients meeting each other, and to allow more time for cleaning.
• Any staff that show symptoms or are a potential risk for transmission are asked to self-isolate.


What are the risks?
¥ It has been shown that viral transmissions can be reduced significantly by hand washing, wearing gowns, protective masks and gloves. Use of anti-viral nasal swabs and mouth rinses are also effective measures. We have very high standards of cross-infection and decontamination which have been further augmented by using all the measures we highlighted in this document
¥ Aerosol that may be produced when talking, sneezing and during some dental procedures can suspended in the air as a potential source of infection which we wish to keep to a minimum, however:
• Our normal dental suction reduces aerosols by over 90%
• Our normal face masks filter 60% of remaining particles, and the protective masks (FFP2 and FFP3) filter 94-99%. We will wear the mask appropriate to the category of procedure.
• Our room air filtration system is rated to achieve 6-12 ACH (air changes per hour) to filter viruses and contaminants from the atmosphere in the treatment rooms.
• We use hypochlorous which is much more stronger than Domestos or bleach and a strong germicidal UV light (UVGI)
• Scientific evidence has shown that modern dental practices, thanks to high level of cross infection control, are extremely safe places to prevent disease transmission provided that these measures are vigilantly applied.
• Our decontamination procedures are audited and our practice is regulated and monitored by the Care Quality Commission (CQC) who carry out regulatory inspections periodically.

We acknowledge and thank all our patients and staff for their understanding and patience at this time.

If you have any questions regarding this policy or about your dental care at our practice please do not hesitate to contact us.

Please click here for the questionnaire

Many thanks

Professor Wright