Dental practices and other healthcare facilities in Kentucky can resume treatment as part of the state’s plan to reopen its economy, though the governor’s office advises that their operations will be “vastly different” compared to before the COVID-19 coronavirus pandemic.
“To do this safely, make sure you are going above and beyond. This is our proof of concept in the medical community. We have to prove that we can do this the right way,” said Governor Andy Beshear.
The governor said the phased healthcare services reopening is the first step under the Healthy at Work initiative he introduced on April 21 to help businesses reopen safely when the time is right.
After the governor’s announcement, a workgroup including the Kentucky Board of Dentistry, the Kentucky Dental Association, the Kentucky Dental Hygienists’ Association, the State Dental Director’s Office, the Kentucky Oral Health Coalition, and the University of Kentucky and University of Louisville dental schools released guidelines for practice.
“Doing this right is about saving lives, making employees safe, and making sure the people they serve are safe when we reopen,” said Beshear.
From the Governor’s Office
Effective April 27, healthcare practitioners including hospital outpatient settings, healthcare clinics and medical offices, physical therapy settings, chiropractic offices, and optometrists can resume non-urgent and non-emergency services.
Dental offices also may resume non-urgent and non-emergency services but with enhanced aerosol protections.
“This is intended to be a phased, gradual reopening so that we can do this thoughtfully, safely, and see the consequences of our actions to make the necessary adjustments,” said Dr. Steven Stack, commissioner of the Department for Public Health.
Stack emphasized that this is a phased and gradual reopening of services and that a COVID-19 surge may require adjustments. Current guidelines include:
- All healthcare practitioners should maximize telehealth rather than in-person services in all phases.
- Healthcare facilities should eliminate traditional waiting room or common seating areas and use non-traditional alternatives such as having patients wait in the parking lot and calling them into the office by phone or text.
- Healthcare facilities should maintain social distancing of at least six feet in all possible settings and employ other steps to minimize direct contact between individuals.
- All healthcare workers, patients, and others should be screened for temperature and COVID-19 symptoms upon arrival in the office.
- Staff should be required to stay home when sick.
- Staff should plan for and ensure enhanced workplace sanitizing, enhanced hand hygiene compliance, and easily accessible hand sanitizer throughout the facility.
- Healthcare settings must be able to procure necessary personal protective equipment (PPE) via normal supply chains.
- All healthcare providers and staff must wear surgical or procedural masks and gloves while in the facility.
- All patients and others in the facility must wear a surgical or procedure mask.
The Department of Public Health is currently seeking additional input from dentists and other professionals in outpatient settings with high aerosol risks on higher-level mask and airflow considerations to help ensure the safety of patients and staff.
From the Workgroup
Despite authorization to resume care, the workgroup said that each practice may work toward a phased, gradual reopening of services and that a surge of COVID-19 cases in the state may necessitate adjustments, especially if PPE supplies run low for frontline healthcare workers.
The workgroup’s guidelines for teledentistry, COVID-19 screenings for staff and patients, and admission are in line with what the governor’s office recommended, in addition to sanitizing the facility, handwashing and other hygiene measures, and proper PPE use. Plus, the workgroup offered more extensive guidelines regarding aerosols.
For example, dental procedures should include rubber dam use and high-speed evacuation (HSE). Also, atraumatic restorative procedures that arrest dental disease without generating aerosols should be considered.
Use N95 masks, which eliminate 95% of airborne particulates, or use a combination of a Level III surgical mask, a face shield, and an HSE system with a disposable tip with an interior bore of 8 mm minimum. The HSE tip should be attached to a vacuum system that meets the manufacturer’s guidelines for evacuation volume.
N95 mask usage should comply with the recommendations of the Centers for Disease Control and Prevention, the Occupational Safety and Health Administration, and the National Institute for Occupation Safety and Health. Users must be medically cleared to use them, and they must fit-test their use.
Patients who are positive for COVID-19 who can’t be otherwise rescheduled should be scheduled for the last appointment for the day. Staff providing treatment should use a gown, gloves, an N95 mask or Level III mask/face shield/HSE system combination, goggles with side protection, face shield, and hair covering. Dental surfaces should be disinfected after the patient is dismissed and before the first patient is treated the following morning.
Medically vulnerable patients should be scheduled first in the day to prevent them from being exposed to a day’s worth of airborne viruses and other pathogens.
Furthermore, the workgroup says that practices may ask dentists to present proof that they have tested negative for COVID-19, with a test that’s less than 72 hours old. When testing isn’t available, robust screenings and temperature taking must be followed.
Plexiglas or other clear barriers should be installed between the front office or checkout desk and waiting areas to reduce airborne viruses and bacteria. Staff should be masked and gloved. Pens used by patients and visitors should be considered the property of the user once used. Credit cards should be disinfected before they are used by staff.
Offices should offer follow-up screenings of their patients two or three days after treatment for signs and symptoms of COVID-19 and take appropriate steps if their conditions have changed. And, signage explaining these changes in procedures could be used to educate patients and reflect the practice’s commitment to ensuring the patient’s safety.