A detailed breakdown of the protocols our office has implemented following the B.C. guidelines for dental office's.
Ambrosi Place Dental Care Operational Plan
COVID 19 Safety Plan
June 1st 2020
Dr. Jason Wasylyk
Our Operational Plan is based on Public Health Guidance from the province of British Columbia and recognizes that government and public confidence will be paramount throughout this State of Emergency and that enhanced procedures are required for us to do our part to prevent further outbreaks. We have designed this reopening plan to keep all of our patients and team members safe and believe we are able to provide an amazing standard of care while upholding the most up to date principles in protection from this disease.
The other document that makes up our return to work plan is the College of Dental Surgeons of BC “Transitioning Oral Healthcare to Phase 2 of the COVID-19 Response Plan.” Both of these documents will be posted in the clinic for your reference.
PRIOR TO REOPENING CLINIC
We will adhere to a scheduling protocol to address backlogs of emergency and urgent care prior to scheduling elective treatment. Dentists will meet with staff and thoroughly review and explain Ambrosi’s Operational Plan. This will be considered mandatory training before returning to work.
Protocols are as follows: -
-Prescreening of COVID symptoms at time of booking
- Text/call to chair policy
- Patient greeting on arrival/screening/sanitizing
- Proper hand hygiene
- Donning and doffing and introduction to new PPE elements
- Handling of the actual dental procedure (NAGP vs AGP), including proper PPE for both
- Disinfection of the operatory
- Sterilization of equipment/instruments - Patient exit protocols
- Physical (social) distancing
- Increased disinfection of high touch surfaces - Respiratory etiquette
- Dress code regarding scrubs and footwear
- Screening of all team members at start of each workday
We will be posting signage relating to proper hand hygiene, respiratory hygiene, and physical distancing in common areas such as waiting rooms and washrooms. We will be posting signage relating to donning and doffing of PPE.
We will be employing a Screening Questionnaire for all patients, prior to appointment and at appointment.
On arrival patients will be screened with screening questionnaire and be asked to wait in the building foyer until a team member calls upon them. Team member providing screening will or have appropriate PPE. When the patient is seated in their operatory they will be asked to wash their hands immediately.
We will, where possible, ensure physical distancing for patients and staff including arrange furniture in waiting areas to allow for physical distancing between chairs, where not possible masks will be employed. Break rooms will be limited. Patients are never to be left alone, they are to be escorted through the office. Disposable products are used when possible. Workers are in pods to limit cross communication. You have reviewed OFAA Worksafe protocols.
We will conduct an inventory of available personal protective equipment (PPE) supplies and assign one staff member to be responsible for maintaining an appropriate inventory of PPE.
All non-essential items will be removed from waiting rooms and operatories (magazines, coffee bar, display models, couch, chairs, and carpet).
Signage will be placed to direct patient flow and ensure social distancing where applicable.
A physical barrier will be placed at reception where social distancing is not possible.
Waste baskets will be provided for disposal of disposable PPE and laundry baskets for storage of used washable PPE.
All team members and dentists will self-monitor for COVID-19 symptoms and will not report to work if they have any symptoms. Staff may see their family doctor and may return to work after 48 hours symptom free
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 the responsibility of the dentist leading the team for the day. This will be recorded and scanned into the computer. For further clarity refer to the CDSBC document “Transitioning Oral Healthcare to Phase 2 of the COVID-19 Response Plan.”
Disinfection of operatories will follow accepted protocol as found in our Standard Operating Procedures Manual using Cavicide wipes. Sterilization of instruments will be carried out as per Standard Operating Procedures using the Ultrasonic as applicable and M11 autoclave or Statim as applicable for the instrumentation as required
Respiratory hygiene includes wearing a mask when physical distancing is not possible, utilizing physical distancing when it is possible, if you must cough - cough into your elbow not your hands.
When receiving deliveries, team members must wear gloves and masks when collecting and/or accepting parcels and disinfect the parcels and surfaces they contact. A clean package is marked with a large check mark.
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 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.
Team members must follow established donning and doffing protocols relating the PPE they are using at the time.
Bibs, drapes (as required), eye protection will be provided to the patient as PPE.
Team members must not wear scrubs to/from work.
Patients who are COVID-positive will not be seen in our clinic and will be referred to the hospital for care.
INITIAL PATIENT CONTACT (PRE-APPOINTMENT)
Dentists must pre-screen patients for vulnerability and pre-existing conditions (i.e. over age 70, comorbidities, pulmonary disease, cardiac disease, diabetes, or immunosuppressed or immunocompromised) and when possible should schedule these patients at the beginning of the day if it is determined they need to be seen for in person treatment. Otherwise they should be reappointed.
Team must interview patients prior to booking re: - Exhibiting COVID-19 symptoms in past two weeks using Screening Questionnaire for COVID-19 (Appendix A); and patients may be advised of protocols they can expect on arrival. Patients who report symptoms and/or have been advised by Public Health to self-isolate, must not be booked for treatment until they have been asymptomatic for 14 days. Patients with suspected or proven COVID-19 that have a dental emergency must be referred for treatment in a designated emergency clinic. Appointments must be scheduled with sufficient time between appointments to minimize the potential for contact with other patients.
PATIENT ARRIVAL PROTOCOL
Patients are advised to wait in the building foyer and wave through the clinic window to let us know they have arrived. Patients will wait in the foyer until they are called upon. Patients must attend their appointments alone unless circumstances require assistance (e.g. 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, caviwipes 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 are asked to wash their hands once they are in their operatory. 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/periapical 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 will 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.
DURING DENTAL CARE
Patients will rinse with antiseptic mouthwash (1-1.5% hydrogen peroxide) for 30-60 seconds before any procedure. The high-volume evacuators should be used primarily.
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. Aerosol-generating medical procedures (AGMPs) An AGMP is any procedure conducted on a patient that can induce production of aerosols of various sizes, including droplet nuclei.
PPE for OHCPs and staff
Every effort is made to make PPE available and accessible at the point-of-care with patient. OHCPs must receive training in and demonstrate an understanding of:
- When to use PPE
- What PPE is necessary
- How to properly don, use, and doff PPE in a manner to prevent self-contamination
Safe donning and doffing practices must be followed. PPE should be removed in the following order: gloves, gown, protective eyewear (if separate from mask), mask and perform hand hygiene immediately afterwards. Hand hygiene should occur according to best practices for putting on and removing PPE.
For further information see: http://www.bccdc.ca/Health-Professionals-Site/Documents/COVID19_IPCGuidelinesCommu nityBasedAlliedHCPsClinicSettings.pdf
LOW RISK NON-AEROSOL GENERATING PROCEDURES PPE: surgical masks ASTM level 3 (minimum), eye protection and gloves must be worn.
Appropriate PPE should be worn for cleaning operatories. At minimum wear a gown (for further clarity a gown is required if patient was COVID + confirmed or to screening otherwise this guideline indicates one will not wear a gown that was used during treatment to clean a room), gloves, surgical mask and protective eyewear. If wearing a long-sleeved impervious gown, a fresh gown is needed for cleaning. Patients can put on their community mask if they have one. Patients should make payments using debit or credit cards. 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. Post operative care will be administered via telephone when possible.
Appoint a staff person responsible for Infection Control (Covid-19) Disinfect debit machines after each use. 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, who was working, and the lengthen and shorten appointments so we know who was here potentially at the same time
External service providers and deliveries 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, or if they are on self-isolation or quarantine as per relevant public health directives, they should not enter the community-based care setting, and should be advised to follow up with local public health or their healthcare provider. External service providers should:
Make adjustments to reduce contact where feasible, e.g., 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
- Be instructed by staff on the importance of hand hygiene with ABHR and when and how to perform hand hygiene, e.g., when entering and exiting the setting, and after touching any surfaces in the community-based care environment
- Masks, tissues, ABHR and a no-touch waste receptacle are available for staff, patient, essential companion, and external service provider to use at screening at each entrance
- All staff and external service providers are logged at entry to the facility
- Essential deliveries that are unable to be left outside occur through a single access point
If at any point you have any questions, or feel unsafe at work or unsure of any of the protocols outlined it is your responsibility to contact Dr. Jason Wasylyk and tell them your concerns. He can be contacted as follows: Dr. Jason Wasylyk (250) 469-3455 or email@example.com
Prescreening of COVID symptoms at time of booking
The booking phone call sheet
You will also use this phone call to advise patient of what to expect on arrival at their appointment:
- Nobody is to accompany the patient (unless required)
-They will be advised the door to our office is locked and they are to wave through the glass to let us know they have arrived and they are to wait in the foyer.
- Greeting at door, and another screening (temperature) about COVID, hands will be , 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/feverish, cough, sore throat, headache, sneezing, loss of smell, or runny nose? If you answered YES, and have only one symptom, then stay home and do not return until you are fully recovered. If you answered YES, and have 2 or more of the symptoms, then 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 re appoint 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?
F. Determine if the patient is high risk - do they have any of the following: - Heart disease - Diabetes - Immunocompromised - Severe respiratory illness (moderate to severe asthma) - Over 70 years old - Severe obesity - Chronic kidney disease/dialysis - Liver disease – Pregnant
Tell patient to call us to cancel appointment if any of these symptoms come up.
Patient greeting on arrival/screening/sanitizing Patient is to be greeted at the door. Patient will be screened using the form on the following page and must be negative for all COVID symptoms and have a temperature less than 38C (unless the patient’s fever can reasonably be attributed to a dental issue such as pulpal/periapical dental pain and intraoral swelling). Team member providing screening will wear PPE (gloves, gown, mask, eye protection).
Patient Screening Form - In office
1. Do you have a fever or have felt hot or feverish anytime in the last two weeks? YES NO
Patient temperature at appointment: ________. If greater than 38C reschedule.
2. Do you have any of these symptoms:
Dry cough? YES NO
Shortness of breath? YES NO
Difficulty breathing? YES NO
Sore throat? YES NO
Runny nose? YES NO
3. Have you experienced a recent loss of smell or taste? YES NO
4.Have you been in contact with any confirmed COVID-19 positive patients, or persons self-isolating because of a determined risk for COVID-19? YES NO