Patient Healthcare Worker Interactions
SADA COVID-19 Guidelines, May 2020
Oral Health Care Provider-Patient Contact Guidelines
Oral Health Care Provider-Patient Contact Guidelines
Although the COVID-19 virus has been identified in the saliva of patients testing positive for COVID-19 (Sabino-Silva, Jardim, & Siqueira, 2020), the path of transmission in dentistry during AGP is not yet clear. We thus need to assume that all AGP pose a high risk of transmission. In contrast to the SARS crisis (2003) in which no OHC provider died (https://jada.ada.org/article/S0002-8177(14)62542-3/pdf), presumably because of adequate sterilisation techniques, many OHC provider deaths have been reported during the COVID-19 crisis. No evidence exists that links these deaths to their profession. It has been shown that viruses may stay alive, airborne for hours, and on hard surfaces for days after exposure (https://www.cdc.gov/coronavirus/2019-ncov/hcp/dental-settings.html).
Initial Contact
- Maintain social distancing at the meet-and-greet stage. Take patient histories with patients wearing masks. A medical-grade mask is recommended for the OHC worker. The looped around the ears, three layered/or any other suitable mask is adequate (only against droplet emission).
- Intra-oral x-rays—use the best clinical judgements—should not be done without the appropriate PPE as for AGP. Taking all appropriate care, to obtain valuable information, to aid in the diagnosis and treatment of patients.
- Take extra-oral x-rays as indicated for each patient.
- The person taking the extra-oral x-ray should wear PPE (mask, eye protection, disposable gloves and clothing that covers all visible skin), as the patient will not be wearing a mask during the procedures. Be aware of droplet dissemination and take immediate action in the unlikely event of contamination. (Change clothes and PPE with appropriate personal sanitising. Standard of care to be applied at all times.)
Patient-Related Factors
Pre-contact
The patient could be provided with disposable head and footwear, and the exposed skin should be washed to lower the risk of OHC worker–contaminated surface contact. However, no scientific evidence exists to support the efficacy of these. The patient must rinse their mouths immediately with H2O2 (1% for 2 periods of 30 seconds each) or povidone-iodine rinses (0.5%) as well as nasal spray can be of benefit (https://papers.ssrn.com/sol3/Papers.cfm?abstract_id=3563092)(https://www.nature.com/articles/s41368-020-0075-9.pdf).
The use of Listerine and chlorhexidine is not supported by the literature against COVID-19; hence, SADA does not advise the use of these.
In droplet or AGPs, it would be optimal to cover the patient fully, exposing only the face to guard against possible contamination. The patient's comfort and well-being should be a priority. This is similar to standard practice in a theatre setting; however, the drapes (water resistant) need to be clean but not sterile. These items need not be disposable; to reduce costs, it could be recycled in an appropriate manner. In low socio-economic environments, the measures set out above could be a large cost-saving measure, although patient inconvenience would be more.
In Contact
The patient’s comfort must be the first priority, but unnecessary movement from underneath the drapes, such as scratching and touching the face, must be discouraged and these actions done on their behalf.
Post Contact
Although not scientifically tested or proven, we strongly suggest that the patient use the same rinsing procedure as before contact at the completion of the appointment. This would reduce the possibility of nosocomial infection. It is further suggested that they also wash their faces with water for 20 seconds to reduce droplet contamination during the procedure. This is in line with government proposals on sanitation and adds to the safety of the patient, who may have been exposed to a higher viral load.