- The following answers have been copied directly from the RCDSO website. Please refer there for more information -
Are there any restrictions for treating patients who screen negative for COVID-19?
Patients who screen negative for COVID-19 may be treated using standard IPAC protocols, for all procedures, both aerosol and non-aerosol generating.
The minimum PPE required for treating these patients includes: eye protection OR face shield, gloves and ASTM level 2 or 3 procedure/surgical mask.
If desired, dentists may choose to use a fit-tested N95 mask and a protective gown when treating patients who screen COVID-19 negative.
Must I have floor-to-ceiling walls and a door that can be closed in all my operatories?
Patients who screen COVID-19 positive must be treated in an operatory that is capable of containing an aerosol, which means floor-to-ceiling walls and a door or other barrier that can be closed.
Patients who screen COVID-19 negative may be treated in your existing operatories.
Please note: The requirements for office preparation, appointment scheduling, patient arrival, PPE, cleaning and disinfection and aerosol-generating procedures, as outlined in the Guidance Document, apply for all patients.
What type of dental procedures require dentists to wear gowns?
For the purpose of aerosol and non-aerosol-generating procedures performed on patients who screen COVID-19 positive, isolation gowns are sufficient.
Isolation gowns protect the exposed skin and clothing of health care providers. They also protect visitors and patients because they prevent the transfer of microorganisms and body fluids.
For major surgical procedures (e.g. osteotomies, use of rigid internal fixation, etc.), sterile surgical gowns are required. Surgical gowns are sterile textile gowns (i.e. have gone through the sterilization process). Health care providers wear these gowns when they are working in a sterile environment.
Reference: Health Canada Personal protective equipment against COVID-19: Medical gowns
What is fallow time?
Fallow time is the amount of time, measured in minutes, needed for the clearance and/or settling of infectious viral particles after performing an aerosol generating procedure. This time depends on the number of air changes per hour and the possible use of an in-operatory air cleaner (e.g. HEPA filtration) to increase the effective air changes per hour (eACH) for a specific operatory. Fallow time begins when patients and staff have exited and the operatory is vacant.
How should the operatory be managed after performing an AGP for a patient who screens COVID-19 negative?
At the end of the procedure all staff and patients exit and the operatory is vacant.
PPE are doffed outside the operatory. Following the fallow time, the operatory may be cleaned and disinfected, and prepared for the next patient.
How should the operatory be managed after performing an AGP for a patient who screens COVID-19 positive?
At the end of the procedure all staff and patients exit and the operatory is vacant.
PPE are doffed outside the operatory. During the fallow time, dentists must not remain in the operatory to write up patient charts. Following the fallow time, the operatory may be cleaned and disinfected, and prepared for the next patient.
Unless otherwise calculated, the fallow time is three hours, timed from when the staff and patients exit and the operatory is vacant. The fallow time may be reduced following an HVAC assessment and if additional mitigating measures have been implemented. See the guidance document for further details.
At the end of the fallow time, appropriate PPE is donned and the operatory is cleaned and disinfected, especially clinical contact and other high-touch surfaces, using an appropriate hospital-grade low-level disinfectant.
What do we tell a patient if they screen positive for COVID-19?
A patient who screens positive for COVID-19 infection should self-isolate and contact their primary care provider or Telehealth Ontario at 1-866-797-0000 to determine next steps, or visit an assessment center to get tested.
Are N95 respirators required for all treatment?
Refer to our latest guidance: COVID-19: Managing Infection Risks during In-Person Dental Care.
Fit-tested N95 masks are only required for aerosol-generating procedures on patients who have screened or tested positive for COVID-19.
For those patients, care MUST be provided using enhanced precautions (i.e. fit-tested N95 mask [or equivalent, as approved by Health Canada), gloves, eye protection and face shield and protective gown).
- If possible, use a rubber dam to decrease possible exposure to infectious agents.
- If possible, use high-speed evacuation to minimize aerosols.
For patients who have screened negative for COVID-19, they may be treated using standard IPAC precautions (procedure/surgical mask, eye protection and gloves), for both aerosol and non-aerosol generating procedures. However, dental personnel have the option, for these patients, to use a fit-tested N95 mask, a face shield and a protective gown if desired.
Do N95 respirators require fit testing?
N95 respirators require a tight fit for protection against aerosols. Fit testing is required for each clinical staff member and for each brand or model of N95 respirator. In other words, the fit test is only applicable to the specific respirator model, unless the manufacturer indicates otherwise.
Can I reuse N95 respirators?
N95 respirators are disposable. However, it is possible to extend the use of N95 respirators under certain circumstances. Extended use refers to the practice of wearing the same N95 respirator for several patients, without removing the respirator between patient encounters. Extended use over one day is possible for non-AGP by protecting the N95 respirator with a level 2 or 3 mask, or a face shield. For AGP, N95 respirators are single use.
Can dentists and their staff use washable/reusable gowns instead of disposable gowns?
Yes, both disposable and reusable/washable gowns are acceptable. As with any personal protective equipment (PPE), attention must be paid to the donning and doffing procedure in order to avoid contaminating the user.
Reusable/washable gowns must be changed and laundered after each patient use.
Please note: reusable/washable gowns must be laundered either on-site or at a commercial laundry facility. Home laundering is not permitted.
Public Health Ontario (Best Practices for Environmental Cleaning for Prevention and Control of Infections in All Health Care Settings) and the Canadian Standards Association (http://shop.csa.ca/en/canada/sterilization/z314102-15/invt/27030462015) have listed the following requirements for the on-site laundering of reusable/washable gowns in dental offices:
- There must be a dedicated space, physically separate from other areas of the laundering facility.
- The space must contain a sorting area for soiled items that is kept under negative pressure.
- If the dental office is unable to comply with these requirements, another option is to use a commercial laundry service.
- Household laundering and laundromats do not meet these requirements.
- While awaiting on-site laundering or pickup for transportation to a commercial laundry facility, reusable/washable gowns should be stored in laundry bins/containers lined with a barrier (such as a garbage bag) to avoid contamination.
- For on-site laundering, use hot water and an appropriate detergent. If the items are heavily soiled, a disinfectant (e.g. chlorine bleach) may be added.
Scrubs worn as clinic attire may be laundered at home.
What type of clothes and PPE are receptionists required to wear?
Like clinical staff, staff who do not have clinical responsibilities must change their clothes and shoes upon reporting to work and when leaving to return home. Non-clinical staff may wear casual shoes and clothes for work or scrubs, as per the office policy. Clothing worn in the office must not be worn outside of the office and should be laundered after each shift.
If there is a physical barrier at reception, no additional PPE is required.
If there is no physical barrier, an ASTM level 1 procedure mask is required.
Physical distancing should be maintained among all staff, including when in the reception area.
There is a shortage of disposable gowns. Can I use a fabric lab coat instead of a gown?
The use of lab coats instead of gowns is discouraged and should only be used as a last resort because they do not provide the same degree of protection. Most lab coats have V-necks and/or do not have elastic bands at the wrists. Because of their design, they can expose the healthcare worker’s skin/clothing at the neck and wrist area.
The front buttons of lab coats can also pose risks of contamination during the donning and doffing procedures.
In the event of a disposable gowns shortage, reusable gowns would be the preferred alternatives.