Covid-19 Protocols

Protocols to Reduce and Manage Risk

 A. Office

o   Stagger patient appointments and see less patients per day

o   Prioritize patients and procedures according to urgency

o   Alter staff schedule to stagger and minimize the number staff in the office at the same time

o   Stay informed of current BC epidemiology and adjust office practices to adapt regularly and frequently

o   Allow time in between patients to do extra infection control procedures

o   Alternate use of operatories when possible to allow aerosols to settle

o   Where possible, minimize use of AGMP when non-AGMP alternative is available 

o   Schedule known AGMP procedures at the end of the day or before lunch to allow the most time for aerosol settling

o   Schedule patients considered high-risk for getting severe Covid-19 whose treatment cannot be deferred at the beginning of the day (eg. age 70 years and over, immunocompromised, pre-existing serious respiratory disease, serious heart conditions, severe obesity, diabetes, chronic kidney disease, liver disease, pregnant patients etc)

o   Clinical staff must only direct patient to the front desk but not leave the operatory themselves until they have properly doffed the contaminated PPE using proper doffing procedure.

o   Update website regularly to inform patient of changes implemented due to Coronavirus Pandemic

o   Restrict access to patients only. Inform patients that they must come alone and report ahead of time if an accompanying person must attend with them

o   Accompanying persons must wait in the car or at a location outside of the clinic. If that is not possible (eg. caregiver of child or person with disabilities) accompanying person must also be screened for Covid-19 and asked to bring and wear a non-medical mask throughout their presence in the office

o   Space out the reception chairs 

o   Provide hand sanitizer near the entrance and encourage patients to perform hand hygiene

o   Signage on both patient access doors restricting access if they have respiratory symptoms

o   Signage for physical distancing throughout the office

o   Use disposable barriers where possible to cover operatory equipment

o   Soap and hand sanitizer will be available throughout the office along with proper hand hygiene posters to encourage compliance

o   Removal of fabric chairs and extraneous furnishings from the clinical area

o   Continue Infection Prevention and Control (IPAC) protocol as defined by CDSBC

o   Frequent and at a minimum of TWICE daily disinfection of high touch surfaces and common areas according to schedule laid out by the person responsible. Communication with other staff members to ensure this has been completed at a minimum of twice a day

o   Periodic review of this document as well as the office Formal Exposure Plan to update as needed

o   Contact information collected (name, phone number/email address) and logged on all who enter the office (deliveries, postal workers etc.) to aid public health contact tracing should that be necessary

o   No touch greetings will be encouraged


B. Staff

o   All staff must do a Covid-19 self-assessment the day before a shift AND the morning of a shift. If there are symptoms of respiratory illness THEY MUST NOT COME TO WORK. Symptoms include but not limited to fever, chills, new or worsening cough, shortness of breath, sore throat, new muscle aches or headache, new gastrointestinal symptoms. They must notify the dentist at their earliest convenience so that the back up staff member can be notified and asked to replace them. If replacement staff is not available, patients must be rescheduled

o   All staff will be expected to log their symptoms daily

o   If staff member develops symptoms during their shift, they must don or keep their mask on, perform hand hygiene, notify dentist and leave the facility as soon as it is possible

o   All staff will be expected to be cross-trained to help out members who cannot attend work due to illness

o   All staff will have a buddy system replacement when possible

o   All clinical staff will change out of work clothes worn under PPE before leaving the office

o   Clinical shoes must be left at the office and disinfected where possible

o   Wearing non medical masks to and from work will be recommended

o   All staff will be required to be familiar with and adhere to the office Formal Exposure Control Plan

o   Clinical staff will don PPE in the panoramic room when possible and doff in operatory

o   Staff will immediately contain the dirty side in and place reusable PPE into receptacle for processing

o   Staff will only bring PPE through ONE path directly into the area where it can be processed (through the front area and into the door closest to the laundry machines)

o   Area around the washer must be disinfected twice a day AND every time it is accessed throughout the day

o   Front desk staff will not enter clinical area unless absolutely necessary and if so, must wear a surgical mask and eye protection or face shield

o   Front desk and clinical staff will communicate via “scheduler sticky notes” by using call buttons to alert the intended party. 

o   Breaks will be staggered as much as possible and staff are encouraged to wear their non medical masks while on break if physical distancing is not possible

o   Staff are encouraged to leave the office for lunch if physical distancing is not possible

o   Shared utensils MUST be washed BEFORE use or staff will bring their own utensils from home for day use

o   Refrain from using shared coffee maker. If using coffee maker, must perform hand hygiene BEFORE and AFTER use

o   Hand hygiene must be performed following office Formal Exposure Control Plan

o   No jewellery on the hands and wrists will be permitted during patient treatment

o   No artificial nails (eg acrylic nails) for clinical staff

o   Use chair side air purifiers during treatment to help control environment

C. Patients

o   All patients must be screened for Covid-19 over the phone and/or email prior to their appointment AND upon arrival

o   All patients will be instructed to report changes that will affect their Covid-19 screen and informed that they will not be permitted if symptoms are detected upon arrival

o   All patients will be advised to attend the office wearing a non-medical mask that they will keep on until the time of the treatment and placed back on after treatment prior to leaving clinical area

o   Attempt to complete the treatment in one visit to minimize need to return

o   No longer offer hot towel service after appointment to minimize spread of droplets between patient and staff

o   Encourage patients to bring their own set of wired headphones should they wish to watch and listen to Netflix entertainment during their appointment. We will place barriers on the remote control but cannot offer the in-office headset to minimize cross-contamination

o   Recall exams will only be done when dentist is not actively treating a patient. Qualified staff will makes notes and take necessary xrays and photos so that dentist can evaluate later to book the patient back in for assessment and treatment. In case of urgent need for assessment, staff will notify dentist and dentist will doff PPE, perform hand hygiene, don new and appropriate PPE and do the exam when possible

o   Clinical staff will greet patient on arrival, offer hand hygiene, do quick assessment and record (take temperature, visual assessment of health) and bring them directly into operatory.

o   If clinical staff is not available when patient arrives, front desk staff will perform hand hygiene, put on appropriate PPE (mask and eye protection), offer patient hand hygiene, do quick assessment and record (temperature and visual assessment of health. They will then direct patient to wait in the reception chairs with their non-medical mask on while maintaining physical distance with others who may be in the office until clinical staff member can bring them to the operatory

o   Patient Covid-19 assessment form will be filled out in the operatory or ideally emailed and completed at home and returned to the office

o   If 1% hydrogen peroxide pre-treatment rinse is used, patient is to expectorate back into the cup as opposed to the sink to reduce contamination of the faucet and surrounding area. The cup can be drained into the sink taking care to minimize splatter before depositing into waste container

o   Patients will be reminded to perform hand hygiene before leaving office