COVID-19 emergency guidelines

05/03/2020

Coronavirus: safety protocols in the dental practice

The role of dentists and dental operators in preventing the spread of Coronavirus

The COVID-19 virus first appeared in the Chinese province of Hubei and spread gradually, its impact has now reached global level and has become the number one issue for all media.

During this “Coronavirus emergency”, the question of biosafety has become a priority, so an adequate, careful application of protocols takes on an essential role in the activities carried out in dental practices.

What are the guidelines to be followed?

 

  1. Fairness: treat all patients equally
  2. Compliance with basic hygiene rules: wash your hands at the beginning of the day and between each patient. Do not wear nail polish, as it leaves recesses that can harbour micro-organisms. Nails should be well cut. Take off jewellery and watches that you’ll take home later.
  3. Use of personal protective equipment:
    • Gown with simple designs, if possible with long sleeves.
    • Disposable caps.
    • Latex or nitrile gloves, to be changed every 15-30 minutes, since they lose their barrier effect. Obviously, they must be changed after each patient, or if they break.
    • Masks of type II or IIR. They must be changed for each patient, and never stored in your pocket or placed near your neck (they will be contaminated with fluids from the patient). If they get wet, they lose their barrier effect, so they must be changed.
    • Always wear safety glasses. The eyes are an open wound, so it is mandatory to protect them. Use of visors instead of glasses increases protection and avoids splashing your face mask (even though this must still be changed).
  4. Use a rubber dam to avoid the water nebulised from the turbine mixing with the saliva of the patient.
  5. Scrupulously follow the sterilisation process:
    • Use appropriate Personal Protective Equipment (clothing, cap, glasses, plastic apron and special thick gloves over latex gloves).
    • Immerse instruments in disinfectant immediately after use. Check that the disinfectant product meets all requirements of an effective disinfectant and respect concentrations, time and temperature recommended by the manufacturer.
    • Follow good washing practices. Always immerse material to avoid contaminated aerosols.  Whenever possible, use a covered ultrasonic tank (avoid handling instruments and aerosols in the atmosphere). A thermodisinfector is the best solution, as the instruments go directly from the mouth of the patient into the machine and come out clean, dry and thermo-disinfected with hardly any handling by staff.
    • Make sure instruments are dried thoroughly. Apart from damaging them, leaving moisture on instruments may invalidate the sterilisation process.
    • Bag and seal correctly. Fill ¾ of the bag, leaving 3 cm to the seal edge and cut the bag to 1 cm. Mark the bag with the date it was sealed if the sealer does not have an automatic tracking system.
    • Sterilise in a type B autoclave. Do not stack pouches, and do not let them stick to the walls of the autoclave, so that the vapour can circulate.
    • Check the chemical indicators on each pouch, perform a Helix test daily and a spore test weekly.
  6. Protect surfaces in the practice as much as possible, using disposable material (drapes on counter tops, barrier film over handles, dental chair covers, radiography machine covers, etc.)
  7. Thoroughly clean the dental chair with a surface disinfectant after removing the protective films. Always perform these steps in the same order. Bleach is used for counter tops and furniture, as well as for cleaning floors. Always start with the cleanest equipment and progress to the most contaminated.
  8. Ventilate the room whenever possible, including the waiting room.

We hope these guidelines will be of use to you. These are fundamental rules, valid not only for the coronavirus, and should accompany medical staff and operators in their daily activities, with or without the Coronavirus emergency.

Gema Maeso

Article by Dr. Gema Maeso, specialist in preventive and community dentistry.  European Board in periodontics certified.

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