TOOTH ACHE AT THE TIME OF A PANDEMIC
The objective of this article is to highlight the effort our dental practice, Crest Clinic, has taken to ensure safety and protection of patients from cross infection, at this time of a pandemic era. It is imperative that we reassure the general public that visiting a clinic for a dental emergency is safe.
It is unfortunate that the world has to face this health crisis, an event that no country was ready for. The SARS CoV-2 has affected an alarming number of individuals, and indirectly much more so. Proactive steps taken by the government to contain and mitigate COVID-19, though welcomed, hasn't been easy for anyone, and life as a result has come to standstill. With bare essentials becoming a luxury, and a cautious lifestyle with masks & hand sanitizers, the last thing one could expect at this time of a lockdown is a tooth ache!
A study published in a reputed medical journal, Global Burden of Disease (2017), has reported that the tooth decay is the most commonly occurring health condition in a population. WHO estimates that the dental disease affects nearly 3.5 billion people, that's about half the world's population!
That said, virologists at the Centre of Disease Control-USA, expect the mitigation of the global pandemic to last for several months, and certain dental health issues cannot wait that long for intervention. The question here is "How safe is it to visit a dental clinic for your dental emergency at the time of a pandemic?"
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. COVID-19, caused by SARS-CoV-2, is now the primary cause of concern for everyone at the moment. Acknowledged as droplet infection, some studies have also shown airborne transmission of the disease.
Cross infection can happen anywhere, be it from a shopping cart in supermarket, or the dumbbell weights at a gymnasium. What one could least suspect as a potential carrier, could be a source of cross infection, including mere exchange of currency notes!
A dental clinic too, holds the risk of cross infection. Besides improperly sterilized instruments, the seat of the dental chair or even the spittoon can cause cross infection.
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/appointment-scheduler). In the online form, the patient has to make a self declaration about travel history, any contact with an infected individual, and signs & symptoms of COVID-19. Any individual who is at a risk of COVID-19 will be asked to self quarantine for a period of 21 days. Pain management of such patients will be discussed over the phone. A course of appropriate medication will be prescribed. The said patient will be attended to immediately after the isolation period.
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 also 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 equivalent) filtration mask, face shield, and 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 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.
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