Babin Dentistry Operational and Exposure Plan

HEALTH HAZARDS OF COVID-19

COVID-19 has been declared a global pandemic and a public health emergency in British Columbia. It is a virus that can cause respiratory illness and can lead to hospitalization and death. The effects of COVID-19 are expected to be much more severe than for seasonal influenza because most people will not have any immunity to the virus. Seniors and people with underlying health issues (including heart disease, diabetes and lung disease) are at a higher risk of hospitalization and death, but young and healthy people are also at risk.

SYMPTOMS

Symptoms of COVID-19 are likely to include fever, cough, sneezing, sore throat and difficulty breathing.

TRANSMISSION

Exposure to COVID-19 can occur by:

• Breathing in droplets in the air that are generated when people cough or sneeze • Close contact with other people (e.g. shaking hands or hugging)

• Touching contaminated surfaces and then touching the face, mouth, or food.

Note that touching a contaminated surface and then touching another surface may cause the virus to transfer from one surface to another.

COVID-19 can be transmitted even by people who are not displaying symptoms of the disease. People who may be infected with COVID-19 should not come to work. This includes people who:

• Have symptoms of COVID-19

• Have travelled outside of Canada within the previous 14 days (including USA) • Have been exposed to someone with COVID-19

• Share a home with someone who has symptoms of COVID-19

• Share a home with someone who has been exposed to COVID-19

STATEMENT OF PURPOSE

Our company is committed to providing a safe and healthy workplace for all of our staff. A combination of measures will be used to minimize worker exposure to COVID-19, including the most effective control technologies available. Our work procedures will protect not only our workers, but also other workers who enter our facilities. All employees must follow the procedures outlined in this plan to prevent or reduce exposure to COVID-19. NOTE: this information is subject to change once we are given further information and instruction from the governing bodies in the coming days and at our discretion

INFECTION CONTROL

All of the modifications for dentistry are based on reducing the risk of spreading infection— from pre- appointment triage to physical distancing to personal protective equipment (PPE). The COVID-19 illness is especially challenging because infected people may not have any symptoms and do not know they are infected. For this reason, infection control measures must be followed in full because each works together with the others to reduce the risk of the spread of infection.

WORKER TRAINING

Our workers will receive training in the following:

• The risk of exposure to COVID-19, and the signs and symptoms of the disease

• Safe work procedures to be followed, including hand washing, physical distancing, PPE and cough/sneeze etiquette

• Location of washing facilities, including dispensing stations for alcohol-based hand rubs

• How to seek first aid

• How to report an exposure to or symptoms of COVID-19.

A team member will be assigned as Infection Control Officer to help monitor compliance.

Babin Dentistry’s operational plan is based on CDA, BCDA, CDSBC and CDHBC guidance and recognizes that enhanced protocols and procedures are required for us to do our part to prevent further outbreaks.

PRIOR TO REOPENING

• Dentists will adhere to a scheduling protocol to address backlogs of emergency and urgent care prior to scheduling elective treatment.

• Dentists provide team with copies of Babin Dentistry’s operational plan and directives from the above mentioned governing bodies and be available to review and explain as needed

• Dentists will post signage relating to proper hand hygiene, respiratory hygiene, and physical distancing in common areas such as waiting rooms and staff rooms.

• Dentists will place hand sanitizer at entryway and throughout the clinic.

• Dentists will where possible ensure physical distancing for patients and team including arranging furniture in waiting room to allow for physical distancing between chairs.

• Dentists will remove magazines, pamphlets, toys, and other-essential items from the waiting areas and operatories.

• Dentists will, whenever possible, place markers throughout the clinic and reception area to indicate where patients are to stand to interact with administrative staff to maintain physical distancing.

• Where physical distancing cannot be maintained in the reception area, Dentists:

  • Will place a transparent barrier at the reception desk to ensure separation between staff and patients during interactions OR

  • Ensure reception team wear masks, gloves and protective eyewear.

• When physical distancing between patents and team is not possible, staff and dentist will wear masks, eye protection and gloves.

• Clinic will provide closed laundry / waste bins for disposal of PPE

• Clinic will remove all non-essential contents to facilitate enhanced infection control following aerosol generating procedures.

GENERAL TEAM REQUIREMENTS AND PHYSICAL DISTANCING

• Clinic will limit the number of staff in the clinic. Staggering of shifts and breaks will be implemented and physical distancing during breaks and while providing patient care, where possible, will be observed by staff.

• All team will self-monitor for Covid-19 symptoms before reporting to work each day and refraining from coming to the clinic if symptoms are present. Staff with mild symptoms may see their doctor and return to work after 48 hours non-symptomatic hours.

• Staff will be pre-screened at the beginning of each shift (Appendix B)

• Staff will not wear scrubs to or from work. Staff will also not wear “outside clothes” in the clinic – In the highly infective COVID-19 environment, all dental office staff should wear scrubs at work. Scrubs and shoes should be only worn in the office and should be put on when entering the office at the start of the day and removed at the office at the end of the day. In addition, Movement between the clinical area and the front office should be minimized.

PPE (Personal Protective Equipment) is a key line of defense for dental office staff in preventing infection. In a pandemic environment, all dental office staff should be using the appropriate PPE. The necessary PPE is indicated by the provincial dental regulator, and it is based on the dental care being provided, or function in the dental office (e.g. reception, room cleaning, etc.). It is also based on the risk level for the patient as determined by the pre-appointment and appointment arrival screening questionnaires.

• Staff who are required to wear PPE will be provided instruction re proper donning and removing PPE

• Staff will wash or disinfect hands thoroughly before and after any contact with patients, after contact with contaminated surfaces or equipment, after removing PPE, and follow established PPE protocols.

RECEIVING DELIVERIES

Minimize transmission risk with procedures such as:

• Wear gloves when collecting and/or accepting mail or packages.

• Wipe entirely the exterior of every box delivered with a paper towel and soap & water solution
  or sanitizing wipe depending on your supplies.

• Boxes remain untouched for 15 minutes prior to being opened.

• Clean all surfaces that were touched by deliveries with soap and water mix or sanitizing wipes.

INITIAL PATIENT CONTACT (PRE-APPOINTMENT)

• Dentists will pre-screen patients for vulnerability and pre-existing conditions (i.e. over age 65, pulmonary disease, cardiac disease, diabetes or immunosurpressed or immunocompromised) and when possible will schedule these patients at the beginning of the day.

• Clinic will interview patients the day prior to appointment re:

  • Exhibiting Covid-19 symptoms in the past two weeks using the Screening Questionnaire for Covid-19 (Appendix A)

  • A Patient Screening Form will be completed (Appendix D) and patients should be advised of protocols they can expect on arrival

• Patients who report symptoms and / or have been advised by Public Health to self-isolate, will not be booked for treatment until they have been asymptomatic for 14 days.

• Patients with suspected or proven Covid-19 will be asked to return home and contact public health

• Appointments will be scheduled with sufficient time between appointments / staggering of arrival times to minimize the potential for contact with other patients

PATIENT ARRIVAL PROTOCOL

• Patients should be advised to telephone the clinic from outside upon arrival.

• Patients should wait in their vehicle or outside the clinic until called upon to enter the premises.

• Paperwork should be emailed ahead or paperless where possible

• Patients should attend their appointments alone unless circumstances require assistance at which point one other guest may attend.

• Patients and guests will sanitize hands immediately upon entering the clinic.

• Staff should accompany patient throughout the clinic to minimize touching of surfaces

• Patients and any accompanying guests will 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

• Patient and accompanying guests temperatures will be taken and recorded, and patients with temperatures exceeding 38degrees C will not be seen unless the patients 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 will be deferred for a minimum of 14 days and patients advised to seek medical advice.

DURING DENTAL CARE

The following transmission based precautions will be implemented into usual clinical protocols and inflectional control procedures during the Covid-19 crisis:

GENERAL PRECAUTIONS

• Patients should rinse with antiseptic mouthwash (1% hydrogen peroxide) for 30- 60 seconds before any procedures

• Extra Oral radiographs should be used whenever possible

• Use of air/water syringe should be minimized

• The use of high volume evacuators should be used primarily

*PPE – SEE BCDA website

PATIENT DISMISSAL

• Patients should make payments using debit or credit cards.

• Receipts should be emailed where possible

• Patients and guests should sanitize or wash hands immediately before exiting the clinic.

SANITIZATION

• Clean and disinfect: touch surfaces will be disinfected at least twice daily, including chairs, tables, door handles, clothes hangers, countertops, staff-room surfaces, lab areas, desks

• Staff sharing will be discouraged – pens, phones, headsets, etc

• Debit machines will be disinfected after each use.

• Touch surfaces and common areas will be cleaned and disinfected throughout the office frequently.

END OF DAY

• Thoroughly clean and disinfect all surfaces including floors.

• Dispose of all PPE using standard waste procedures.

• Staff and dentists will change from work clothes and shoes (or use shoe cleaner) into personal clothing before leaving the clinic.

EXPOSURE TO COVID-19

In the event of suspected exposure to Covid-19 staff should immediately self-isolate and advise employer and call a health professional for further direction.

Acknowledged by Dentists and Office Staff below that this is the Operation Plan for Babin Dentistry.