March 29, 2020 (See the March 6, 2020 update)
***CDC Releases Guidance on Interim Infection Prevention and Control Guidance for Dental Settings During the COVID-19 Response. Check out this update.
***Trump signs CARES Act into law. Check out the details.
AGD continues to monitor COVID-19 and work to identify resources and information that are useful to our members. Our team is also working with federal agencies and legislators to advocate for policies that support general dentists, focusing on issues related to delivering patient care and managing your practice.
The following includes some resources, news, reminders and resources for guidance as you prepare for COVID-19 patients in your office, seek to answer questions from your patients and work to limit further spread.
Supply Management Reminder: Due to high demand, some manufacturers and distributors are limiting the sale of protective gear, including face masks. AGDVANTAGE supplier DHPI is still honoring our agreement and will continue to sell these supplies at the AGD discount. Supplies are limited. For more information, check out AGDVANTAGE.
Standards of Care are determined by the State Board. To assist members in monitoring the latest COVID-19 information affecting their dental practice in their individual states, AGD has gathered and organized state-by-state information on a dedicated Coronavirus resources page.
For the most updated information on measures in your state, visit your state department of health web site. Check out CDC State and Territorial Health Department for more information.
Government of Canada
Centers for Disease Control and Prevention
- CDC Interim Infection Prevention and Control Recommendation
- CDC State and Territorial Health Department
- CDC Developing Guidance Regarding Responding to COVID-19 in Dental Settings
- CDC Situational Updates
- CDC Healthcare Professional Resources – COVID-19
- CDC Fact Sheet and Handouts
- CDC Standard Precautions
- Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care
- USPHS CDO Newsletter # 46 - March 14 2020 (COVID-19 and Dental Practice: A Message from the CDC Division of Oral Health)
Center for Medicare and Medicaid Studies
- Press Release on the CMS COVID-19 Elective Surgeries and Non-Essential Procedures Recommendations
- CMS General Provider Telehealth and Telemedicine Tool Kit
- CMS COVID-19 Elective Surgeries and Non-Essential Procedures Recommendations
- Current Emergencies Website
U.S. Department of Labor
- Guidance for Workers and Employers Explaining Paid Sick Leave and Expanded Family and Medical Leave Benefits Under the Families First Coronavirus Response Act
Internal Revenue Service
- Plan to implement Coronavirus-related paid leave for workers and tax credits for small and midsize businesses
Food and Drug Administration
Occupational Safety and Health Administration
Assistant Secretary for Preparedness and Response
Plan to implement Coronavirus-related paid leave for workers and tax credits for small and midsize businesses (U.S. Internal Revenue Service)
Transmission routes of 2019-nCoV and controls in dental practice (International Journal of Oral Science)
Most Important Coronavirus Question: Will I Get Sick And Die? (American Council on Science and Health)
The Coronavirus and Your Job: What the Boss Can—and Can’t—Make You Do (The Wall Street Journal)
Practice Management Reminders and Resources
Managing your practice during this time is difficult. Use the content list below when preparing for communication with your patients and team members.
Determine necessity for dental visit, if not already determined by your local authorities.
- Assess urgency of patient visit, including pain, swelling or trauma.
- Always follow and use the recommended CDC standard precautions.
- Ensure that your office is being cleaned and disinfected frequently, especially all common areas.
- If possible, consider having patients wait in their car until you are ready. This can be set up in advance by instructing them that you will call or text when you are ready. Be sure that they wash their hands upon arrival.
- Check in on your patients' status. Take temperatures of patients or ask that they take their temperature before arriving at the office. Ask patients to reschedule if they have COVID-19 symptoms, have been exposed to those with COVID-19 or have a travel history that might make them at risk.
- Consider teledentistry options and whether there are ways to use technology to assess patient needs and determine the necessity for the patient visit.
- Understand office policies and procedures regarding staff health issues. Know what your leave time policy is for staff members who may have a medically compromising condition.
- Try to minimize aerosol effects using rubber dam and highspeed suction, consider oral rinsing prior to treatment and disinfect surfaces.
- Follow local and state guidelines for operations. The COVID-19 situation is very fluid, and guidelines are changing daily. Stay abreast of local, state and federal guidelines.
- Understand that the supply chain for personal protective equipment (PPE) is under heavy strain. Consider limiting patient care to those in urgent or emergent need (pain, swelling, trauma).
- Enhance the PPE when aerosol procedures are being performed (welder-style shield) in addition to mask.
STEPS TO STOP THE TRANSMISSION
Places of employment, including dental facilities, may be ideal for the spread of disease. Below are recommendations for how to stop transmission:
- Communication with patients and employees
- Provide training on occupational safety and health (OSHA training) that includes infection prevention, to all new employees and annual training to all employees.
- Review the proper use and disposal of personal protective equipment (PPE) for all employees.
- The dental team should advise patients and staff who are experiencing acute respiratory illness, including symptoms of fever, cough or shortness of breath, to remain home and reschedule appointments.
- Emphasize staying home when sick, proper respiratory etiquette and hand hygiene for all employees:
- Place posters that encourage correct cough/sneeze etiquette as well as proper hand hygiene at the entrance to your workplace.
- Provide tissues and no-touch disposal receptacles for use by employees and patients.
- Instruct employees to clean/disinfect their hands between patients with an alcohol-based hand sanitizer that contains at least 60-95% alcohol. Soap and water should be utilized preferentially if hands are visibly contaminated and must always be used before eating and after toileting
- Provide soap and water as well as alcohol-based hand rubs in multiple locations throughout the workplace.
- Advise employees to avoid touching their eyes, nose and mouth.
- Perform environmental surface cleaning and disinfection:
- It appears that the coronavirus may live on hard surfaces, at room temperature, for up to several days.
- Provide disposable disinfectant wipes so that commonly used surfaces (e.g. doorknobs, keyboards, armrests, remote controls, countertops, desks, etc.) may be decontaminated.
- No additional disinfection beyond routine cleaning and disinfection is recommended at this time.
Reprinted from Compliance Training Partners
SIMPLE PREVENTATIVE MEASURE REMINDERS
AGD encourages the implementation of a few simple preventative measures to limit the spread of COVID-19:
- Promote the daily practice of everyday preventive actions. We encourage all attendees to practice daily good health habits to prevent the spread of any virus. Please review the Center for Disease Control (CDC) recommendations for everyday preventive actions.
- We are discouraging individuals who are sick, who have been exposed to the virus, or who have traveled to and from an affected area from attending events and to leave events if they begin to have symptoms. If you have symptoms of a virus, which could include fever, cough, and shortness of breath, you are discouraged from attending the event and encouraged to follow CDC guidelines. If you become sick at the event, please promptly follow CDC guidelines and notify event organizer by email or phone. See CDC guidance on what to do when sick.
March 6, 2020
There is a growing body of knowledge about COVID-19, the 2019 coronavirus disease, being released by public health experts around the world. AGD has compiled resources and information for members and will provide regular updates.
According to the Centers for Disease Control (CDC), coronaviruses are a family of viruses common in many animal species, including cats, cattle and bats, and do not commonly infect humans. However, some coronaviruses evolve and are transmitted from animals to humans, and these infections can then spread from person to person. New strains of coronavirus recently identified in humans have included severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV), which caused deadly outbreaks of disease in 2002 and 2012, respectively.
Precautions to Prevent the Spread of Respiratory Disease
The CDC recommends doing the following:
- Avoid close contact with people who are sick.
- Avoid touching your eyes, nose and mouth with unwashed hands.
- Stay home from school or work when you are sick.
- Cover your cough or sneeze with a tissue, then throw the tissue in the trash.
- Clean and disinfect frequently touched objects and surfaces using a regular household cleaning spray or wipe.
- Wash your hands often with soap and water for at least 20 seconds, especially after going to the bathroom, before eating, and after blowing your nose, coughing or sneezing.
- If soap and water are unavailable, use an alcohol-based hand sanitizer with at least 60% alcohol. Always wash hands with soap and water if hands are visibly dirty.
Infection Control: According to the Organization for Safety, Asepsis and Prevention (OSAP), a dental association that advocates for infection-free oral healthcare, the Center for Disease Control recognizes that healthcare facilities may experience temporary shortages of face masks even if they do not care for patients with COVID-19. “If your facility is concerned about a potential or imminent shortage of PPE, CDC recommends you alert your state/local health department and local healthcare coalition, as they are best positioned to help facilities troubleshoot through temporary shortages. Dental health professionals concerned about healthcare supply for personal protective equipment (PPE) should monitor Healthcare Supply of Personal Protective Equipment for updated guidance and be familiar with the Interim Infection Prevention and Control Recommendations.”
Recommendations from Larry Williams, DDS, ABGD, MAGD
- Discuss the current COVID-19 outbreak with your staff. Develop a consistent message that the patient’s well-being is the practice’s No. 1 consideration and that the use of standard precautions keeps everyone safe. You can also find resources on the websites of the OSAP and the World Health Organization (WHO).
- Review the CDC’s standard precaution guidelines with your staff, and make sure that they are being followed.
- Let your patients know that you are practicing these precautions as a routine part of your practice and that your precautions are in compliance with CDC guidelines.
- Download the free public health posters and leaflets offered by the CDC and WHO, and share them with your patients. Among the relevant topics are hand-washing (CDC, WHO) and influenza.