DENTAL CARE IN COVID-19 ERA

 

CROSS INFECTION:

Cross infection is the transfer of harmful microorganism from one infected individual to an otherwise healthy individual. Transmission can happen either directly by physical contact or indirectly through a contaminated contact surface or even by air in case of airborne infections. Some of the infections that hold high risk of transmission includes the influenza (flu), Herpes, Hepatitis, Tuberculosis, and Acquired Immune Deficiency Syndrome. A diligent dental care set up can effectively control the cross infection risk of these infections. Handling COVID-19 scare, now the primary concern, shouldn’t be a mammoth challenge for a well equipped healthcare setup.

 

Cross infection can happen from anyone (a food delivery agent) and anywhere (a supermarket). What one could least suspect as a potential carrier, could be a source of cross infection, including mere exchange of currency notes!

 

 

HANDLING CROSS INFECTION AT A DENTAL PRACTICE:

Visiting a dentist should be safe if right sterilization and disinfection protocols are followed. At the time of a pandemic, a clinic has to take additional steps to keep a check on cross infection. In this article a strategy adopted by Crest Clinic to ensure the safety of patients, has been highlighted. 

 

 

THE SEVEN STEP STRATEGY 

TO CURTAIL CROSS INFECTION RISK AT CREST CLINIC

 

1: PRE-APPOINTMENT QUESTIONNAIRE:

No direct walk-ins, patients will be attended to only by appointment, which can be scheduled over phone or through the clinic website. Prior to scheduling the appointment, a patient is asked to fill out a questionnaire through an online portal (www.crest-clinic.com). In the online form, the patient has to make a self declaration with COVID-19 relevant questionnaire. Any individual who is even at a slightest risk of COVID-19 infection will be asked to self quarantine for a period of 30 days. Pain management of such patients will be discussed over the phone. A course of appropriate medication will be prescribed for management of the same or referred to a Government designated COVID-19 Dental hospital.

 

2: PATIENT DISTANCING:

Objective: to prevent cross infection

In line with "physical distancing" guidelines recommended by the WHO, the clinic schedules only one patient at a time. The other operatory will be non functional at the time. No back-to-back appointments, a minimum time interval of 30 minutes between two patients visiting for treatment is enforced. The scheduled patient can walk in for his/her treatment directly into the operatory of the clinic, without having to wait. 

 

 

3: AIR VENTILATION & DISINFECTION:

Objective: air-clean and safe to breathe

a- Ultra-Violet Germicidal Irradiation: Post treatment procedure, UVGI (Philips TUV, Poland) of the operatory is carried out to destroy any airborne pathogen suspended in the air. 

In healthcare, this system is commonly used in hospital operating rooms. Amongst the private dental healthcare providers, Crest Clinic is the first to adopt this disinfection system. Air disinfection of the operatory is done after every procedure for 15 minutes, in a closed and isolated setting. The UVGI is proven to be effective against viruses including coronavirus, bacteria, and moulds. These UV rays destroy the virus by deactivating the genetic material (the RNA structure). 

 

This mode of disinfection with ultraviolet irradiation (UV-C) has gained popularity at this time of pandemic. China and the United States are actively employing UV-C to disinfect hospitals and public transportation system.

 

 

b- Ventilation: Operatory is ventilated for fresh air circulation after every patient visit.

 

c-High Efficiency Particulate Air filtration: HEPA is a mechanical air filter that forces the air through a fine mesh to filter out aerosol suspension (happens during dental procedure) in the air. Dyson air purifier technology is employed.

 

 

4: HOUSE KEEPING:

Objective: for a clean, pathogen free clinic

All surfaces including spittoon & seat of the dental chair, floor, door knobs, etc are disinfected after EVERY procedure. Hospital grade disinfectants are approved by the EPA (United States Environmental Protection Agency) for use against SARS-CoV-2. They include benzalkonium chloride, sodium hypochlorite, hydrogen peroxide & glutaraldehyde. 

 

 

5: PERSONAL PROTECTIVE EQUIPMENT: 

Objective: Personal safety

Clinician & nurse will wear NIOSH approved PM2.5 (N95 or European equivalent) filtration mask, face shield, and disposable surgical gowns. 

 

 

6: INSTRUMENT STERILIZATION: 

Objective: Basic patient safety measures

This is a guideline every dental practitioner should follow. Every equipment used for the patient follows a cycle of sterilization process;

a- soap + cetrimide solution wash 

b- disinfection in ultrasonic bath 

c- pouched

d- autoclave

e- UV storage

 

The disinfectants used are hydrogen peroxide, glutaraldehyde and chlorhexidine gluconate. The autoclave used is hospital grade "type B".  

 

 

7: BIOMEDICAL WASTE SEGREGATION & DISPOSAL:

Objective: Basic environmental safety measures

A mandatory guideline every clinic must follow to ensure environmental safety. Biomedical waste must be segregated in respective colour coded bin and disposed through government authorised biomedical waste collection contractor.

 

 

Oral health is more important than one could realise. An unhealthy mouth could lead to serious health complications such as cardio-vascular, and endocrine problems. Many dental problems require timely intervention, and the dentist should have utmost responsibility to ensure the clinic operatory is safe for a patient to visit.