Neobook — clinical reference

Pre-appointment Screening Questions and Instructions

Purpose

The purpose of this section is to provide all levels of OHC practitioners with general information on the standard of care for infection control measures and to prevent transmission (spread) of SARS-CoV-2 in the clinical practice setting.

Transmission Dynamics (key points)

Transmission of the SARS-CoV-2 virus and the associated COVID-19 disease can be life-threatening to susceptible patients and exposed DHCWs. Dental care providers need to be aware and be prepared to reduce the risk of transmission and to prevent any possible infectious disease (Ather, Patel, Ruparel et al., 2020).

SARS-CoV-2 transmission predominantly occurs through airborne droplets. Therefore, the use of protective equipment, including gloves, masks, protective outerwear, protective surgical glasses and shields, is strongly recommended to protect eye, oral and nasal mucosa (Meng, Hua, Bian et al., 2020; Peng, Xu, Li et al., 2020). If there is a shortage of N95 (or equivalent) respirators, an ear loop mask can be worn to protect the respirator from surface contamination.

First Contact

A patient’s first contact with the OHC facility is normally with the receptionist. This potential weak link must be the first line of defence, infected patients, asymptomatic and early infected with COVID-19 will be seen. Receptionists therefore need a checklist, be it a handwritten or digital document, where patient names are recorded with corresponding questions that shall become part of patient records. Such documentation is valuable for epidemiological tracing, should an infection occur in a practice. Front office staff should be equipped with a temperature camera if this is not done at entrance to the building. Any patient with a raised temperature should be referred to the principal DHC worker preferably before entering the premises.

Front office staff require specific instruction on how to manage this crisis, and it cannot be assumed that they have the skills to perform this very important task. If doubt exists, receptionists and all other staff designated to this duty should be provided with the following information. Any questions should be addressed to the principal OHC worker as it is his/her duty to implement the education and manage patient treatment and may not be assigned inappropriately to staff.

Any person, whether it is a patient, accompanying person or other to be pre-screened and perform hand hygiene at the entrance. Also, see practice management regarding staff.

Pre-appointment Screening Questions and Instructions

Does the patient have flu-like symptoms: fever > 38°C, cough, sore throat or difficulty breathing?
Has the patient or any member of their household tested positive for COVID-19? When was the diagnosis made and when did the patient experience their most recent symptoms, if any? **See clinical notes below.
Has the patient experienced any flu-like symptoms (see question 1) in the past fourteen (14) days?
Has the patient been in contact with someone outside their household who has tested positive for COVID-19 or had flu-like symptoms?
Has the patient been in contact with somebody with flu-like symptoms who has also received a negative or inconclusive COVID-19 test?
Did the patient travel to areas marked by transmission of COVID-19?
Has the patient worked in or attended a health care facility where COVID-19 patients were being treated?
Has the patient been recently admitted with severe pneumonia?
Other: chills, loss of taste, loss of smell, muscle pain, headache?

** Clinical note:
a. ‘Time-since-illness-onset and time-since-recovery strategy (non-test-based strategy): Persons with COVID-19 who have symptoms and were directed to care for themselves at home may discontinue home isolation under the following conditions: i. At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (e.g. cough, shortness of breath); and, ii. At least 7 days have passed since symptoms first appeared.’;
b. ‘Test-based strategy: Persons who have COVID-19 who have symptoms and were directed to care for themselves at home may discontinue home isolation under the following conditions: i. Resolution of fever without the use of fever-reducing medications and, ii. Improvement in respiratory symptoms (e.g. cough, shortness of breath) and iii. Negative results of an FDA Emergency Use Authorised molecular assay for COVID-19 from at least two consecutive nasopharyngeal swab specimens collected ≥ 24 hours apart (total of two negative specimens).’; and
c. ‘Individuals with laboratory-confirmed COVID-19 who have not had any symptoms may discontinue home isolation when at least 7 days have passed since the date of their first positive COVID-19 diagnostic test and have had no subsequent illness’ (https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-in-home-patients.html; https://www.cdc.gov/coronavirus/2019-ncov/hcp/dental-settings.html).

If a patient answer affirmatively to any of the above questions, the OHC staff member should defer to the OHC provider for instruction on scheduling decisions as they require clinical assessment.

If a patient is suspected of having contracted COVID-19, they should be first isolated in a separate room and given a surgical mask. Dental treatment should be limited to pharmacological treatment and the patient referred to the nearest COVID-19 testing centre for confirmation.

It is essential that the clinician assess their environment to assure optimal isolation and ventilation; it is even more essential to use appropriate PPE and appointments be kept short.

COVID-positive or suspected patients need to be scheduled for the end of the day or in areas where they can be managed safely (a dedicated facility or a hospital theatre environment recommended). Remember to factor in enough time for ventilation specific to your own environment (see: practice ventilation) and disinfection of the treatment area between cases.

Emergency COVID-19-related attention: Know your local COVID-19 Hotline number and have it posted in a prominent visual place for easy referral.

Emergency COVID-19-related symptoms that require immediate attention:

Persistent pain
Pressure in the chest
New confusion
Bluish face
Lips and inability to arouse.