American PPE Guidelines

Colorado Springs PPE

1. Non-Aerosol generating procedures (NAGP): Any dental procedure that does not produce aerosolized particles. These include exams, hand scaling, simple extractions, or orthodontic procedures.
2. Aerosol Generating Procedure (AGP): Any dental procedure where aerosolized particles are expected to be generated by dental instrumentation. This includes the use of ultrasonic scalers, high-speed handpieces, surgical handpieces or air-water syringes at any point in the procedure.

CDC guidelines: https://www.cdc.gov/coronavirus/2019-ncov/hcp/dental-settings.html 

Colorado PPE table: https://cdaonline.org/wp-content/uploads/2020/05/PPE-Guidance-Poster-050420.pdf

CODH ( Colorado Dental Hygiene Association) : http://codha.org/covid-19/ 

ADHA return to work: http://codha.org/wp-content/uploads/2020/05/ADHA_TaskForceReport.pdf 

ADHA hygiene guidelines: https://www.adha.org/resources-docs/2016-Revised-Standards-for-Clinical-Dental-Hygiene-Practice.pdf 

CDC Using PPE: https://www.cdc.gov/coronavirus/2019-ncov/hcp/using-ppe.html 

IPAC: https://www.cdc.gov/mmwr/PDF/rr/rr5217.pdf 

CDC IPAC: https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html

Colorado Public health:https://data-cdphe.opendata.arcgis.com/datasets/colorado-covid-19-positive-cases-and-rates-of-infection-by-county-of-identification 

Niosh N95 info:

 https://www.cdc.gov/niosh/topics/respirators/ 

https://www.osha.gov/SLTC/etools/respiratory/index.html 

https://www.cdc.gov/coronavirus/2019-ncov/hcp/respirators-strategy/index.html

Summary of required PPE:

Treatment to be completed in the operatory with dental healthcare provider (DHCP)

Low risk: NAGP - Non-aerosol generating procedure includes: 

ortho retainer checks, hand scaling, prophy, recall exam

• Level 2 or above
• Face shield or protective eyewear
• Gloves
• A lab coat or gown
• For x rays or photos eye protection OR face shield 

Mod/High risk AGP - aerosol-generating procedure include:

Restorative, endodontic, ultrasonic scaling, surgical periodontal hygiene, ortho de-bonding/banding

• Level 3 or NIOSH-approved N95 filtering facepiece respirator or higher 
• Face shield 
• Protective eyewear
• Gown or lab coat
• Gloves
• Booties and bonnet (but NOT for ortho new bonding)

High Risk - NO treatment in a general dental office 

Disinfecting treatment rooms for all procedures: Follow ADA &  IPC standards

• Level 2 or above
• Protective eyewear or goggles 
• Face shield
• Gloves
• Gown

Reception area: 

Front desk Staff (Administration staff/Treatment coordinator/Manager)

• Level 1 mask minimum or cloth mask 
• Protective eyewear or a clear barrier/plexiglass separation
• Patients and visitors to wear masks at all times

Staff screening patients

• Level 2 mask
• Gown or lab coat
• Eye protection
• Face Shield preferred

Disinfection of Reception area: Follow ADA & C IPC standards

• Level 2
• Protective eyewear 
• Face shield
• Gloves

AGPs should ideally take place in an AIIR.

Information about Airborne Infection Isolation Rooms (AIIRs):

• AIIRs are single-patient rooms at negative pressure relative to the surrounding areas, and with a minimum of 6 air changes per hour (12 air changes per hour are recommended for new construction or renovation).
• Air from these rooms should be exhausted directly to the outside or be filtered through a high-efficiency particulate air (HEPA) filter directly before recirculation.
• Room doors should be kept closed except when entering or leaving the room, and entry and exit should be minimized.
• Facilities should monitor and document the proper negative-pressure function of these rooms.

Airborne infection isolation rooms – Single-patient rooms at negative pressure relative to the surrounding areas, and with a minimum of 6 air changes per hour (12 air changes per hour are recommended for new construction or renovation). 

Air from these rooms should be exhausted directly to the outside or be filtered through a high-efficiency particulate air (HEPA) filter directly before recirculation. Room doors should be kept closed except when entering or leaving the room, and entry and exit should be minimized. 

Facilities should monitor and document the proper negative-pressure function of these rooms.

Air changes per hour: the ratio of the volume of air flowing through a space in a certain period of time (the airflow rate) to the volume of that space (the room volume). This ratio is expressed as the number of air changes per hour.

Optimize the Use of Engineering Controls and Indoor Air Quality

• Optimize the use of engineering controls to reduce or eliminate exposures by shielding HCP and other patients from infected individuals. Examples of engineering controls include:
• Physical barriers and dedicated pathways to guide symptomatic patients through triage areas.
• Remote triage facilities for patient intake areas.
• If climate permits, outdoor assessment and triage stations for patients with respiratory symptoms.
• Vacuum shrouds for surgical procedures likely to generate aerosols.
• Reassess the use of open bay recovery areas.
• Explore options to improve indoor air quality in all shared spaces.
• Optimize air-handling systems (ensuring appropriate directionality, filtration, exchange rate, proper installation, and up to date maintenance).
• Consider the addition of portable solutions (e.g., portable HEPA filtration units) to augment air quality in areas when permanent air-handling systems are not a feasible option.

Pennsylvania PPE guidelines 

1. Non-Aerosol generating procedures (NAGP): Any dental procedure that does not produce aerosolized particles. These include exams, hand scaling, simple extractions, or orthodontic procedures.
2. Aerosol Generating Procedure (AGP): Any dental procedure where aerosolized particles are expected to be generated by dental instrumentation. This includes the use of ultrasonic scalers, high-speed handpieces, surgical handpieces or air-water syringes at any point in the procedure.

PA Pennsylvannia Dental Association https://www.padental.org/Online/Membership/COVID-19/Online/Membership/COVID19.aspx?hkey=1f174b4f-e7c0-4506-8826-66b3206270e3 

Covid Updates http://www.padental.org/covid19 

Pennsylvannia Guidelines updated May 8/20 https://www.porh.psu.edu/wp-content/uploads/Guidance-on-COVID-19-for-Dental-Health-Care-Personnel-in-Pennsylvania.pdf 

CDC guidelines: https://www.cdc.gov/coronavirus/2019-ncov/hcp/dental-settings.html 

Pennsylvania Dental Hygiene https://pdhaonline.org/ 

Department of health https://www.health.pa.gov/topics/disease/Pages/Coronavirus.aspx 

ADHA return to work: http://codha.org/wp-content/uploads/2020/05/ADHA_TaskForceReport.pdf 

ADHA hygiene guidelines: https://www.adha.org/resources-docs/2016-Revised-Standards-for-Clinical-Dental-Hygiene-Practice.pdf 

CDC Using PPE: https://www.cdc.gov/coronavirus/2019-ncov/hcp/using-ppe.html 

IPAC: https://www.cdc.gov/mmwr/PDF/rr/rr5217.pdf 

CDC IPAC: https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html

Standards of practice https://www.cdc.gov/hicpac/recommendations/core-practices.html 

Niosh N95 info:

https://www.cdc.gov/niosh/topics/respirators/ 

https://www.osha.gov/SLTC/etools/respiratory/index.html 

https://www.cdc.gov/coronavirus/2019-ncov/hcp/respirators-strategy/index.html

Summary of required PPE:

Treatment to be completed in the operatory with dental healthcare provider (DHCP)

Low risk: NAGP - Non-aerosol generating procedure includes: 

ortho retainer checks, hand scaling, prophy, recall exam

• Level 2 or above
• Face shield or protective eyewear
• Gloves
• A lab coat or gown
• For x rays or photos eye protection OR face shield 

Mod/High risk AGP - aerosol-generating procedure include:

Restorative, endodontic, ultrasonic scaling, surgical periodontal hygiene, ortho de-bonding/banding

• Level 3 or NIOSH-approved N95 filtering facepiece respirator or higher 
• Face shield 
• Protective eyewear
• Gown or lab coat
• Gloves
• Booties and bonnet (but NOT for ortho new bonding)

High Risk - NO treatment in a general dental office 

Disinfecting treatment rooms for all procedures: Follow ADA &  IPC standards

• Level 2 or above
• Protective eyewear or goggles 
• Face shield
• Gloves
• Gown

Reception area: 

Front desk Staff (Administration staff/Treatment coordinator/Manager)

• Level 1 mask minimum or cloth mask 
• Protective eyewear or a clear barrier/plexiglass separation
• Patients and visitors to wear masks at all times

Staff screening patients

• Level 2 mask
• Gown or lab coat
• Eye protection
• Face Shield preferred

Disinfection of Reception area: Follow ADA & C IPC standards

• Level 2
• Protective eyewear 
• Face shield
• Gloves

AGPs should ideally take place in an AIIR.

Information about Airborne Infection Isolation Rooms (AIIRs):

• AIIRs are single-patient rooms at negative pressure relative to the surrounding areas, and with a minimum of 6 air changes per hour (12 air changes per hour are recommended for new construction or renovation).
• Air from these rooms should be exhausted directly to the outside or be filtered through a high-efficiency particulate air (HEPA) filter directly before recirculation.
• Room doors should be kept closed except when entering or leaving the room, and entry and exit should be minimized.
• Facilities should monitor and document the proper negative-pressure function of these rooms.

Airborne infection isolation rooms – Single-patient rooms at negative pressure relative to the surrounding areas, and with a minimum of 6 air changes per hour (12 air changes per hour are recommended for new construction or renovation). 

Air from these rooms should be exhausted directly to the outside or be filtered through a high-efficiency particulate air (HEPA) filter directly before recirculation. Room doors should be kept closed except when entering or leaving the room, and entry and exit should be minimized. 

Facilities should monitor and document the proper negative-pressure function of these rooms.

Air changes per hour: the ratio of the volume of air flowing through a space in a certain period of time (the airflow rate) to the volume of that space (the room volume). This ratio is expressed as the number of air changes per hour.

Optimize the Use of Engineering Controls and Indoor Air Quality

• Optimize the use of engineering controls to reduce or eliminate exposures by shielding HCP and other patients from infected individuals. Examples of engineering controls include:
• Physical barriers and dedicated pathways to guide symptomatic patients through triage areas.
• Remote triage facilities for patient intake areas.
• If climate permits, outdoor assessment and triage stations for patients with respiratory symptoms.
• Vacuum shrouds for surgical procedures likely to generate aerosols.
• Reassess the use of open bay recovery areas.
• Explore options to improve indoor air quality in all shared spaces.

• Optimize air-handling systems (ensuring appropriate directionality, filtration, exchange rate, proper installation, and up to date maintenance).
• Consider the addition of portable solutions (e.g., portable HEPA filtration units) to augment air quality in areas when permanent air-handling systems are not a feasible option.