From the onset of the COVID-19 crisis in the United States, dental practices have done their part to help slow the illness’ spread. Painful but necessary decisions have led caregivers to indefinitely postpone or cancel cleanings, routine checkups, and other non-urgent patient care, sacrificing business income to reduce infection risk for patients and staff.
Now that many states have opened the door to resuming non-emergency dental care in the ongoing pandemic, dental professionals are understandably eager to return to work and begin addressing a backlog of patient care needs. However, infection risk remains a serious concern for practice leaders, who must adopt appropriate measures to establish and maintain a heightened degree of cleanliness and sanitation while minimizing opportunities for the transmission of disease.
While many organizations are putting measures in place to address distancing and disinfecting heavily used surfaces, few have communicated new policies to address air quality. This article explores how ventilation affects infection control and how air-quality technology can augment the practice’s disinfection processes and procedures.
Clean Air Considerations
There is no single resource spelling out the steps required to safely reopen a dental office. State agencies that regulate dental licensing can provide specific requirements, and the Centers for Disease Control and Prevention (CDC) updated their Interim Infection Prevention and Control Guidance for Dental Settings During the COVID-19 Response as recently as June 17, 2020.
The CDC’s guidance for dental settings includes engineering controls, which refers to a building’s heating, ventilation, and air conditioning (HVAC) systems. In the past, dental healthcare providers may have given little thought to air quality in their offices or dismissed the use of advanced mechanical systems, filtration, and related technologies as prohibitively expensive. But as the world scrambles for effective tools to deal with a highly contagious respiratory disease, many practices are including air-quality improvements in their cleaning and sanitation strategies.
The CDC’s recommendations regarding ventilation systems in dental settings touch on several important areas, including:
- Manage airflow: Protect staff and patients by moving air from clean areas to less clean areas. In other words, where possible, position atomizing dental procedures and other potential sources of airborne contaminants near return-air vents rather than drawing that air past other staff workspaces or patient waiting areas.
- Explore filtration additions: These may include upgrading existing filters or adding separate filtration equipment. An HVAC professional can evaluate how to make such changes safely, without significantly reducing necessary airflow or straining mechanical system components. However, keep in mind that portable HEPA filter devices can offer some added protection when deployed near a patient. The filter’s poition and proximity to the patient are extremely important to be effective.
- Increase outdoor air intake: An HVAC consultant can also help to investigate whether the practice can safely increase the percentage of outdoor air drawn into the space.
- Limit access to ventilation controls: Air quality is best maintained with continuous ventilation, so consider restricting access to temperature setpoint or occupancy controls. Set exhaust fans to run continuously during operating hours.
- Consider using upper-room ultraviolet germicidal irradiation: These systems project ultraviolet light above the heads of room occupants to create a microbial kill zone. Coupled with engineered airflows that circulate the room’s air through the upper portion of the enclosure, this technology has been used for more than a half century to combat the spread of tuberculosis.
The Future of Air & Surface Purification
The CDC also recommends using devices that recreate oxidation and ionization processes found in natural sunlight. In addition to the upper-room systems, several air-purifying products on the market incorporate ultraviolet light, electrostatic screens, and other technology along with low-micron filters. These solutions come in an array of sizes and capacities to suit the application.
Some of these next-generation purifiers (known as air scrubbers) have been proven to not only destroy harmful pathogens, viruses, bacteria, and mold in the air, but also on surfaces. Air purification technology can turn oxygen and humidity from a room into super-oxide ions and hydroperoxides, essentially transforming the air into a cleaning agent. These devices have been shown to remove more than 99% of airborne and surface contaminants, killing pathogens on contact and destroying microorganisms in the air and on surfaces.
These qualities have made air purifiers a common fixture in hospitals and surgical centers. With their increased affordability in recent years and growing awareness of the technology, doctors’ offices, professional sports facilities, hotels, skilled nursing centers, and other businesses and even homeowners have installed air purifiers to enhance indoor air quality.
Air quality in the dental practice has historically been left to the idiosyncrasies of existing HVAC design, but the subject merits careful consideration in the COVID-19 era for its role in creating and maintaining a safe environment for returning patients and staff.
The prospect of resuming non-urgent dental care has practice leaders rethinking infection prevention strategies. They must choose effective safeguards for patients and caregivers while conforming to budgets that may have been strained by months of reduced operations.
Improving air quality offers an affordable and effective means of demonstrating the dental practice’s commitment to providing patients and employees with a safe environment for administering care. By following the CDC’s guidelines and consulting with professionals, practice leaders will likely identify opportunities for mechanical modifications and procedural changes that yield immediate air-quality improvements. Less pressing needs can be implemented over time as budgets allow.
Mr. Thompson is the CEO and founder of GermFree MD, a leading-edge indoor infection control technology company. A lifelong advocate for nature-based solutions for toxin, allergen, and infection control, he educates medical professionals and businesses on safe air and surface protection. He is a thought leader in the indoor infection control space and specializes in helping organizations achieve indoor infection control through ActivePure technology products such as the portable Air & Surface Pro. Originally developed by NASA, ActivePure technology converts ambient oxygen and moisture in the air into stable aerosolized oxidizers that destroy 99.9999% of air and surface pathogens in less than one hour. Buzz also has worked to help thousands of businesses and organizations, including doctors, the US Olympic Wrestling team, and various Major League Baseball teams, discover how to proactively and cost-effectively win against the invisible army of germs, allergens, and toxins that adversely impact health.