HOW TO STAY PROTECTED AND MINIMIZE THE RISK OF CROSS-INFECTIONS IN DENTAL PRACTICE?

On January 30, the World Health Organization (WHO) declared the outbreak of coronavirus, COVID-19, “a public health emergency of international concern”, and on March 11 officially identified it as pandemic, with its spread to over 160 countries around the globe by the end of the month[1].  
 
The virus can spread person-to-person in close contact through small droplets people expel when they exhale or cough. The droplets can accumulate on surfaces, objects, and body parts, where other people can pick them up and transfer the virus into their own eyes, nose, or mouth.
 
Healthcare professionals – including hygienists, dental assistants, and dentists – are frontline defenders against the spread of infection, whatever form it takes. While routine dental practices are already being disrupted as part of social distancing measures, the new coronavirus is a reminder that we all must be hypervigilant about protecting patients, colleagues, and community from the transmission of disease.

Therefore, what needs to be done once the pandemic is over? Will you be ready when patients come back to your dental office to ensure their safety as well as dental staff’s? Hu-Friedy has the solutions that helps you minimize the exposure to cross-infection and blood borne pathogensduring daily procedures to be The Best in Practice for infection control and prevention.

THE HU-FRIEDY CIRCLE OF PROTECTION

Hu-Friedy, in conjunction with the recent acquisition by Cantel and the merger with the Crosstex family of products, is now the global leader in infection prevention with the Circle of protection for patients, staff and instruments. The IMS Cycle is a comprehensive set of solutions and materials that include an efficient and effective dental workflow management process following the International BEST PRACTICES[2], with the same basic rules and standardized procedures for all countries. The main goal for every clinician is using Instrument Management System, consumables, chemistries and single-use disposables is to help minimize the risk of cross-contamination within the dental office.

Following BEST PRACTICE, the standardized steps of a proper Infection Prevention protocol within the dental office are chairside, transportation, cleaning, packaging, sterilization and storage[3]. At the chairside, all PPE are removed before DHCP (Dental Health Care Personnel) leave patient-care areas (mask, exam gloves). Then, new PPE apply before cleaning and disinfecting surfaces in patient-care areas (utility gloves, mask, protective eyewear, gown/jacket/lab coat). Instrument set-ups are protected by using IMS cassettes are placed in a closed, locked container for transport and contaminated sharps and disposables have been discarded. When instruments are brought to the sterilization area, they are kept together throughout cleaning, rinsing and drying, reducing the potential for breakage or loss, in fact minimizing handling of instruments reduces the chance for sharps injuries. Instruments are then packed in containers, pouches or wraps before sterilization. When put in the sterilizer, it’s important to make sure it’s loaded properly and that a regular maintenance as per manufacturer’s IFU’s is performed. At the end of the process, instruments are stored packed in dry, closed or covered cabinets, with a label indication of the date of sterilization.

PROPER FACE MASK USE

CDC and European Guidelines agree that “dental healthcare professionals should wear mouth, nose, and eye protection during procedures that are likely to generate splashes or sprays of blood or other body fluids[4].”Within the PPE, masks are the most discussed within the PPE since the COVID-19 is stated to be a respiratory illness[5], although there are other important infection control methods. Here are some good face mask habits to practice and perpetuate at your dental office, starting with selecting the right mask for the task at hand.

Know how masks are classified and rated
The highest rated masks generally recommended for use in dental settings are PFF2 and PFF3[6] (called N95 in the US) whose respirators filter at least 95% of airborne particles and are proscribed for use when treating patients with or suspected of having respiratory illnesses. Their features comprehend fluid resistance, bacterial filtration efficiency, submicron particle filtration efficiency, differential pressure, and flame spread. Under the ASTM (American Society for Testing and Materials) standards, each mask receives a rating according to its level of protection.

Wear your mask right-side-up and right-side-out
A dental face mask should have three layers: the outside layer is fluid-resistant, the middle layer is for filtration, and the inside layer protects your face. The inner and outer layers are not interchangeable. When masks are color-coded, it’s simple to tell the difference between the inside and the outside. For non-color-coded masks, manufacturer’s instructions need to be checked. Dental face masks are meant to follow the contours of your face. Gaps between your skin and the edge of a mask can let contaminants in. It’s important to orient your face mask properly: the pleats on a face mask should face down, like a waterfall.

Don (Put On) your mask correctly
Before securing your mask, you should use your thumb to make a slight indentation or divot on the nose piece: this will help seat the mask appropriately on the bridge of your nose. After looping your mask around your ears, use your index and middle fingers to mold the nose piece between your eyes and across the bridge of your nose. Next, extend the mask fully over your mouth and chin. If you wear glasses, remove your glasses before donning your mask. Put your glasses back on after your mask.

Doff (Take Off) your mask correctly
Removing a dental face mask incorrectly risks cross-contamination and there’s a proper way to do it too: keep in mind the outer surface of a face mask may be covered in a layer of aerosols, viruses, blood spatter, and saliva. To doff a face mask, put your fingers underneath each of the ear loops near your ear lobes and pull straight down. Then lift the mask off and away from your face and dispose of it. Do not touch the mask itself, and do not wear a used mask outside of the treatment area. Wash or use of alcohol-based hand-rub immediately after mask removal[7].

HAND HYGIENE

Hand Hygiene is part of standard precautions and one of the basic measures for infection prevention. Dental Healthcare Personnel (DHCP) should wash their hands often and thoroughly, as declared by the CDC, to prevent the spread of cross-infections among patients and dental staff.
Clinicians should wash their hands in different times of their everyday routine: at the beginning of the workday; before putting on gloves; after removing gloves; whenever gloves are torn or punctured; before and after eating; after using the bathroom.
To wash properly, wet your hands under warm water, apply soap, and rub your hands together, hitting every part for at least 20 seconds. Rinse and dry your hands thoroughly and turn off the faucet using a disposable towel. You may use instead an alcohol-based rub[8].

Images from WHO, Clean Care is Safe Care

SURFACES

Potential infection is everywhere in a dental practice, from soiled dental instruments and clinical surfaces to the air itself. In fact some viruses, including the novel COVID-19, can be transmitted not only through inhalation of droplets and aerosols containing infectious microorganism, but can also persist on surfaces like metal, glass or plastic. This is why particular care should be used when setting up a room for any dental procedure: all the objects or surfaces that might be touched during the procedure, must be covered with barriers. All surfaces need to be cleaned and disinfected after every procedure[9].
 
When the pandemic of COVID-19 is over and you return to your dental offices, infection control and prevention protocols and guidelines will be more important than ever. Hu-Friedy and its specialists will remain ready to help guide you through the infection control and prevention process by constantly providing you the products and services that ensure the safety of your patients and staff at all times and help you be THE BEST IN PRACTICE.


For more information, please visit our COVID-19 Resource Center or 

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Notes and useful links:
[1]http://www.euro.who.int/en/health-topics/health-emergencies/coronavirus-covid-19/news/news/2020/3/who-announces-covid-19-outbreak-a-pandemic
[2]UK GOV, Guidance - Decontamination in primary care dental practices(HTM 01-05); Germany, RKI-Empfehlung: Infektionsprävention in der Zahnheilkunde – Anforderungen an die Hygiene; Austria, ÖGHMP– Die Österreichische Gesellschaft für Hygiene, Mikrobiologie und Präventivmedizin; France, Practice assessment & good practice guidelines -re´fe´rentiel d’auto-e´valuation des pratiques en odontologie 
[3]CDC, Summary of infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care
[4]CDC – Summary of infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care (p.8)
[5]World Health Organization, https://www.who.int/publications-detail/clinical-management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected
[6]Regulation (EU) 2016/425 of the European Parliament and Council relating to Personal Protective Equipment Regulation (PPE), Link 1 and Link 2
[7]CDC, Summary of infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care
[8]WHO, Clean Care is Safe Care
[9]CDC Guidelines and Environmental Persistence of SARSCoV2