the current state of infection prevention and safety
TRANSCRIPT
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The Current State of Infection Prevention and
Safety Regulations in Dentistry
Mary Govoni, MBA, CDA, RDH
The Current State of the Global Pandemic
COVID‐19 cases– Surging in the U.S. in areas with low
vaccination rates– Also surging in other countries– Delta variant is now said to be the
dominant strain ‐ 97% of cases in the U.S.
– Lambda variant identified in U.S.• Resistance to antibodies and vaccines
– Mu variant identified in FL• Increased transmissibility and resistance to
antibodies and vaccines
– New C.1.2 variant identified in S. Africa
https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidview/index.html
https://www.cdc.gov/coronavirus/2019-ncov/variants/variant-info.html
https://www.healthvermont.gov/covid-19
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3 Types of COVID-19 Patients
• Unvaccinated
• Vaccinated without symptoms
• Vaccinated with symptoms This Photo by Unknown Author is licensed under CC BY
Vaccines
U.S. EEOC states vaccines can be mandated.Exemptions for religious or medical reasons
Some states mandating for all health care workers.Vaccinate or be tested weekly – CA, IL
Federal mandate for employers with >100 employeesVaccinate or be tested weekly
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https://www.cdc.gov/mmwr/volumes/70/wr/pdfs/mm7037e1-H.pdf
https://www.fda.gov/news-events/press-announcements/fda-approves-first-covid-19-vaccine
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Vaccines
Boosters• Immunosuppressed individuals• Experts disagree on boosters for everyone.
https://www.cdc.gov/coronavirus/2019-ncov/vaccines/booster-shot.html
Guidance and Regulations for DentistryOSHA
– Dentistry largely exempt from Emergency Temporary Standard
https://www.osha.gov/coronavirus/ets
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https://www.osha.gov/sites/default/files/publications/OSHA4125.pdf
WORKPLACE SAFETY TOP 10 RECOMMENDATIONS RELATINGTO COVID-19
https://labor.vermont.gov/vosha
https://labor.vermont.gov/sites/labor/files/doc_library/MEMO%20-%20VOSHA%20Workplace%20Safety%20Top%2010%20Recommendations%20Relating%20to%20COVID-19_final.pdf
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• OSHA Guidance for PPE during COVID‐19
https://www.osha.gov/coronavirus/control-prevention/dentistry
Guidance and Regulations for Dentistry• CDC:
https://www.cdc.gov/coronavirus/2019-ncov/hcp/dental-settings.html
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https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fhcp%2Finfection-control-after-vaccination.html#print
https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html
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Guidance and Regulations for Dentistry
https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated-guidance.html
https://www.fda.gov/medical-devices/coronavirus-disease-2019-covid-19-emergency-use-authorizations-medical-devices/personal-protective-equipment-euas
FDA Emergency Use Authorizations
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What does all this mean???
• It’s not back to the “old normal” – pre‐pandemic– OSHA and CDC state that N95 respirators should be worn for AGP’s
– OSHA states that health care settings must follow CDC guidance
– OSHA and CDC also state that respirators and face masks must be NIOSH‐certified, and FDA cleared as medical/surgical masks and respirators
CDC
FDA
OSAH
Is it safe to provide oral health care
services?
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Was the “old normal” really safe?
This Photo by Unknown Author is licensed under CC BY-SA-NC
Is Dentistry safe? It depends…
• Incidence of disease in local area – and prevalence of Delta and other variants
• Vaccination rates for patients and oral health care workers
• Screening of patients and oral health care workers for symptoms
– Questionnaires
– Taking temperatures
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Is Dentistry safe? It depends…
• Protocols for infection prevention
– Environmental disinfection
– PPE
– Aerosol containment• High volume evacuation (HVE)
• Ventilation
• Air purification
Aerosol Production• Aerosol‐generating procedures (AGPs) = use of:
– High speed handpieces
– Air/water syringe
– Ultrasonic scalers
– Air abrasion
– Air polishing
This Photo by Unknown Author is licensed under CC BY-SA
This Photo by Unknown Author is licensed under CC BY-NC-ND Source: HuFriedy Group
Source: Zest Dental
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Aerosol Protection
• Reduce the aerosol dispersed by:– Wearing a higher level of respiratory
protection
– Wearing face shields
– Increasing air exchanges in ventilation system
– Using air purification units in treatment roomsSource: CDC/NIOSH
• High levels of influenza
• Other respiratory illnesses– Tuberculosis
– Measles
– Mumps
– Chicken pox
– Pertussis
– Group A Strep
Respiratory illness among DHCP/OHCW
www.marygovoni.com
This Photo by Unknown Author is licensed under CC BY-ND
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Personal Protective Equipment (PPE)
• Eye protection
– Goggles or face shields
– Protective gowns
– Surgical masks/respirators
– Gloves
This Photo by Unknown Author is licensed under CC BY-SA-NC
Respiratory ProtectionFace Masks• Have varying levels of fluid resistance and particle filtration• Appropriate for non-aerosol-generating procedures• Appropriate for source control – non-treatment procedures
Surgical Masks• Cleared by FDA for medical use – Class II devices• ASTM levels should be indicated on packaging
– indicated on packaging as a “surgical” mask – meets fluid barrier and particle filtration standards
• Additional features– Adjustable nose bridge strip for better fit– Also chin strip for better fit at bottom of mask
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Respirators• Respirators differ from masks in both fit, seal
• Some brands come in multiple sizes for better fit
• N95 Filtering Facepiece Respirators (FFRs)• Commonly referred to as N95s• Surgical respirators (FDA cleared for health care use)
• High fluid resistance rating
• Designed for single use
• Respirators with exhalation valves not appropriate for use in health care settings.
• Respirators must be fit tested initially and annually, although some states may still follow suspension of annual fit testing.
• Each time respirator is donned, wearer must perform a seal check.
https://www.fda.gov/medical-devices/personal-protective-equipment-infection-control/n95-respirators-surgical-masks-and-face-masks#s6
Source: OSHA.gov
Aerosol Protection in Dental Procedures
• Reduce the aerosol produced by:
– Avoidance of AGPs – not realistic
– Selective use of ultrasonic scalers and air polishing/air abrasion
– Using dental dams where possible
– Using high volume evacuation (HVE) for all AGPs
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Layering of Containment Strategies
• HVE• Ventilation• Air purification
HVE is a Key Component of Layering Strategy
• Use of HVE – can reduce aerosol by up to 90%
– https://jada.ada.org/article/S0002‐8177(14)61227‐7/fulltext
– https://www.prweb.com/pdfdownload/18042693.pdf
• Many intraoral and extraoral devices available
• Intraoral devices can be challenging for hygienists
– Typically, no assistant available to manage
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Extraoral HVE Devices
• Attachments to HVE lines in treatment room
– Better positioning of device – smaller• Can be positioned adjacent to the site
– Most treatment rooms already have available
– Less noise
– Less cost
Source: DentaEZ
Increased Use of HVE in a Dental Facility
• Adding more users to the system– Diffusing the power of the system
– Saliva ejector uses 1/2 capacity of an HVE
• Single or dual pump
• Wet or dry
• Ventilation in utility room
• Air flow testing– Critical for aerosol containment
Source: DentalEZ
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Is Your Evacuation System Up to the Task?
• Is the pump undersized for the facility?
– Based on the number of high and low speed lines in each operatory
– How many HVE lines are used at one time?
• How old is the evacuation system pump?
Is Your Evacuation System Up to the Task?
• Is the system maintained regularly?
– Start at the operatory farthest from the vacuum pump
– Cleaning with enzymatic solutions for evacuation systems
– Is the cleaning effective? • Using a bucket and running the solution through the lines
• Using a cleaning system
– i.e. CleanStream™
Source: Monarch – Air Techniques
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Maintenance of the Evacuation System• Daily
– Run an evacuation system cleaner through the lines
• Weekly– Check the solids collectors (traps) and replace if necessary
– Check the intake filter on wet vacs
• Monthly – wet vacs– Change the main intake filter (follow MIFU)
• Quarterly – dry vacs– Check vacuum relief valve
– Check oil levels if dry vac uses oil as lubricant – not needed on newer systems
• Annually– Have service tech perform needed maintenance
Mary Govoni, CDA, RDH, MBA517-214-8223
facebook.com/marygovoniandassociateshttps://www.linkedin.com/in/mary-govoni-and-associates/
www.thecompliancedivas.com
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CE Verification Code:
PREVENTION CONVENTION
This Photo by Unknown Author is licensed under CC BY-NC-ND
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