ADHA Interim Guidance &

A Review of Air Purification Systems

David Reznik, DDSDirector of the Oral Health Center of Grady Health System’s Infectious Disease Program

Gary Severance, DDSExecutive Leader of Professional

Relations, Henry Schein Dental

Disclaimer

The webinar and materials that you will view were prepared for general information

purposes only by the presenter and are not intended to be a substitute for

professional advice, nor purported to be comprehensive. Henry Schein does not

guarantee the accuracy or reliability of the information provided herein and does

not undertake any obligation to update or revise any statements contained herein,

or correct inaccuracies whether as a result of new information, future events, or

otherwise. Any reliance upon any such information is solely and exclusively at your

own risk. Dental and medical professionals must make their own business decisions

and may wish to seek professional advice before acting with regard to the subjects

mentioned herein. Nothing contained herein should be treated as legal, business,

accounting, international, insurance, tax, financial or other professional

advice. Henry Schein shall not be held responsible for any consequences of reliance

upon any opinion or statement contained here, or any omission. The opinions

expressed in these materials are not necessarily the opinions of the presenter,

Henry Schein, or any of their affiliates, directors, officers or employees.

CDC’s Summary of COVID-19 Activity

• Nationally, levels of influenza-like illness (ILI) and COVID-19-like illness

(CLI) and the percentage of specimens testing positive for SARS-CoV-2,

the virus that causes COVID-19, continue to decline or remain stable

• Mortality attributed to COVID-19 also decreased compared to last week

but remains elevated above baseline and may increase as additional

death certificates are processed

CDC’s Summary of COVID-19 Activity

• The national percentage of respiratory specimens testing positive for

SARS-CoV-2 at public health, clinical, and commercial laboratories

decreased from week 20 to week 21

• National percentages by type of laboratory:

❖ Public health laboratories – decreased from 8.4% during week 20 to 7.0%

during week 21

❖ Clinical laboratories – decreased from 6.3% during week 20 to 5.6% during

week 21

❖ Commercial laboratories – decreased from 7.8 % during week 20 to 6.9%

during week 21

CDC’s Summary of COVID-19: Key Points

The percent positivity increased slightly in two HHS surveillance regions:

❖ Region 4 = the southeast

❖ Region 10 = the Pacific northwest

If your community is experiencing no transmission or minimal community transmission

• Dental care can be provided to patients without suspected or confirmed COVID-19 using strict adherence to Standard Precautions

• Given that patients may be able to spread the virus while pre-symptomatic or asymptomatic, it is recommended that DHCP practice enhanced IC whenever feasible

❖“No to minimal community transmission” is defined as evidence of isolated cases or limited community transmission, case investigations underway; no evidence of exposure in large communal setting

If your community is experiencing minimal to moderate or substantial transmission

• Dental care can be provided to patients without suspected or confirmed COVID-19 using considerations to protect both DHCP and patients and prevent the spread of COVID-19 in dental facilities

❖Minimal to moderate community transmission is defined as sustained transmission with high likelihood or confirmed exposure within communal settings and potential for rapid increase in cases

❖Substantial community transmission is defined as large scale community transmission, including communal settings (e.g., schools, workplaces)

CDC’s Summary of COVID-19: Key Points

• The overall cumulative COVID-19 associated hospitalization rate is 73.3

per 100,000, with the highest rates in people 65 years of age and older

(229.7 per 100,000) followed by people 50-64 years (113.4 per 100,000)

• Non-Hispanic Black and non-Hispanic American Indian/Alaska Native

populations have rates approximately 4.5 times that of non-Hispanic

Whites

• Hispanic/Latinos have a rate approximately 3.5 times that of

non-Hispanic Whites

Hospitalization Rates Based on Age

Age Group Cumulative Rate per 100,000 Population

Overall 73.3

0-4 years 4.1

5-17 years 1.9

18-49 years 41.0

18-29 years 20.1

30-39 years 40.7

40-49 years 68.5

50-64 years 113.4

65+ years 229.7

65-74 years 167.6

75-84 years 276.2

85+ years 426.7

ADHA Interim Guidance

on Returning to Work

ADHA Interim Guidance on Returning to Work

“In order to protect the dental hygienist, the dental team and patients, the

American Dental Hygienists’ Association (ADHA) continues to support the

recommendations from the Centers for Disease Control and Prevention

(CDC) that balance the need to provide necessary services while

minimizing risk to patients and dental healthcare personnel (DHCP).

The following considerations have been prepared utilizing guidelines,

regulations and resources from key resources including, but not limited to,

CDC, the Occupational Safety and Health Administration (OSHA), the

American Dental Association (ADA) and the Organization for Safety,

Asepsis and Prevention (OSAP).”

ADHA Interim Guidance on Returning to Work

• Prior to returning to work, all dental team members should be tested for

COVID-19, where feasible, subject to state and local regulations

• Individuals who test positive or present with symptoms should not report

to work and should follow quarantine protocols

• If there is a surge in incidence of COVID-19, consider providing

emergency services only

• Continually monitor risk level incidence, as there may be times when it

will be important to cease nonessential procedures if there is a surge in

COVID-19 incidence

Communication with Your Team

Meet with your employer and the entire dental team to have an open

conversation about:

• Current supply of PPE and new supplies needed

• Screening practice for COVID-19

• Methods to reduce/eliminate aerosol production in the office

• Strategies for social distancing among patients and the dental team

• Scheduling changes for providers to allow for appropriate disinfecting between

patients

Identify one team member who will regularly monitor national resources

and update the entire dental team on key recommendations that will

impact practice, including ADHA’s COVID-19 Resource Center.

Patient Preparation

• Using the telephone or Teledentistry, screen all patients for symptoms

consistent with COVID-19; if the patient reports symptoms of COVID-19,

avoid non-emergent dental care

❖ If possible, delay dental care until the patient has recovered **

• Pre-screening of patients, using Teledentistry, will reduce the number of

in-office patients, as well as post-treatment follow-up appointments

• If forms need to be completed and signed, provide pens to the patients,

and instruct them to keep the pens for their personal use

Special Considerations for Providing Dental Hygiene Care

• High-volume evacuators (HVE) should be available in dental hygiene

rooms, and a dental hygiene assistant should be available during

procedures that require HVE

• Use hand instrumentation versus ultrasonic instruments for periodontal

debridement and scaling procedures

• Use selective plaque and stain removal versus full-mouth coronal

polishing

• Avoid air-polishing procedures

• Do not use the air and water functions on the syringe, together, at the

same time

Fit-Testing N95 Facial Respirators

• OSHA requires initial fit testing for new employees; best practice for

respiratory protection involves the use of N95 respirators custom-fitted for

critical tasks

• Training on fit and seal should be provided prior to use; other masks may

be used for non-critical tasks

• Remove the respirator after every patient

Fit-Testing N95 Facial Respirators

• Fit-test kits are available commercially -- carefully follow manufacturer

instructions; respiratory fit testing:

❖ can be done by employer or outside party

❖ should be done annually thereafter

❖ uses an agent to check whether there is leakage around the respirator

• Remove and discard disposable respirators and surgical masks

❖ Perform hand hygiene after removing the respirator or face mask

– Resources:

• CDC Illustration of COVID-19 PPE for Health Care Personnel

• Hospital Respiratory Protection Program Toolkit: Though designed for hospitals, the information in this resource from the Occupational Safety and Health Administration (OSHA) can be customized for your practice

OSHA Recommendations on N95 Reuse or Past Shelf Life

When alternatives are not available, or where their use creates additional

safety or health hazards, employers may consider the extended use or

reuse of N95 FFRs, or use of N95 FFRs that were approved but have since

passed the manufacturer’s recommended shelf life, under specified

conditions.

OSHA Recommendations on N95 Reuse or Past Shelf Life

NIOSH has tested a sample of N95 FFRs that are beyond their

manufacturer’s recommended shelf life from facilities across the United

States and determined that certain N95 models continue to protect

against the hazards for which they would ordinarily be appropriate.

(for N95 FFRs, this means they are still expected to filter out 95% of particles

of the most penetrating particle size, or 0.3 µm)

Extended Use or Reuse of N95s

• In the event extended use or reuse of N95 FFRs becomes necessary, the

same worker is permitted to extend use of or reuse the respirator, as long

as the respirator maintains its structural and functional integrity and the

filter material is not physically damaged, soiled, or contaminated

• Extended use is preferred over reuse due to contact transmission risk

associated with donning/doffing during reuse

• When respirators are being re-used, employers should pay particular

attention to workers’ proper storage of the FFRs in between periods of

reuse

When Not to Use Expired N95s

Expired N95s generally must not be used when HCP Perform surgical

procedures on patients infected with, or potentially infected with, SARS-

CoV-2, or perform or are present for procedures expected to generate

aerosols or procedures where respiratory secretions are likely to be poorly

controlled (e.g., cardiopulmonary resuscitation, intubation, extubation,

bronchoscopy, nebulizer therapy, sputum induction).

ADHA Interim Guidelines

Team members should leave their shoes at the office, and footwear should

be disinfected daily.

Patient Scheduling

• Patients should be scheduled in a manner that allows for complete

disinfection of operatories

• If possible, decide upon two rooms for each dental hygienist to use, so

that one room can be sanitized and prepared while the dental hygienist

begins using the next room for another patient

• If there is only one room dedicated for dental hygiene care, it is

recommended to increase patient appointment time (e.g., 1.5 hours

per appointment) for appropriate disinfection and room preparation

• Do not double-book appointments

Dental Hygiene Readiness to Return to Work “Chart”

✓ Met with coworkers to discuss strategies for opening practice

✓ Conducted inventory of PPE and sufficient supplies are available to maintain safety of dental team of patients

✓ All dental team members are tested for COVID-19 and/or exhibit no signs of infection and have not been exposed to COVID-19

✓ Community risk level incidence of COVID-19 is low

✓ Able to maintain social distancing at work

✓ All operatories and work areas have been disinfected

✓ Waiting room has been cleaned and all unnecessary objects have been removed

✓ Hand sanitizers are available for patients as they enter the office

✓ Contactless thermometer is available to check patient and staff temperatures

✓ A screening questionnaire is available to screen patients prior to and during appointments

✓ A designated place is assigned to don and doff PPE

✓ Appropriate disinfectant has been obtained to clean operatories

Thank You!

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For more information and a full list of references, please

visit the Henry Schein COVID-19 resource center:

www.henryschein.com/COVID19update