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Coronavirus – Getting Back To Work after Closure: FAQ

You Asked. We answered.  Below find answers from the “Doctors, Start Your Engine… A Roadmap for Re-Opening,” by Mary Beth Kirkpatrick, webinar questions. From Personal Protective Equipment (PPE) and office space protocols to patient health, we’ve got you covered. 

  1. Office Space
  2. Personal Protective Equipment (PPE)
  3. Patient Health
  4. Other

OFFICE SPACE

How many patients do you suggest attending per day or per shift?

Difficult to make a general statement that would fit all.  I would suggest for the first couple of weeks, until you get systems in place that you cut your schedule by 50 percent. This would not include virtual visits. You may find that you can increase that number. The important part will be that there is time for required infection control measures.  A common number that I hear from clients and colleagues is 40 patient per-day for the first week.

If you do not have a separate room, how do you recommend scheduling procedures generating aerosol?

Schedule de-bonds at the end of your clinic. Make a barrier wall between that chair and the next chair. Schedule de-bonds vertically instead of horizontally so there will not be two de-bonds present at the same time. Barrier wall does not have to go to the ceiling – a 5-foot wall would work. Have a solid suction solution to reduce the droplets that are spread.

Are any modifications required for our compressors and suction units, particularly if they are in a closet within the orthodontic clinic (and exhaust into the space)?
Contact your HVAC /air conditioning vendor and ask if this exhaust is for the motor or if the exhaust could contain any contents of the suction unit. This is a question that I am not qualified to answer from an engineering prospective. Aerosol from suction contents would be totally against infection control standards making that closet very dangerous.

Where can you get a divider?

Dividers that I showed in the webinar were crafted with a wood framed and legs bolted to the floor with patterned plexiglass. If you take the photo to Home Depot, I imagine they could direct you to a contractor or carpenter that could do this.

There are hospital type curtain dividers – what do you think of these?

Curtain dividers are in hospitals but often they take the curtain down after the patient leaves and launders the curtain. Not a great answer for an orthodontic clinic. These curtains aren’t visually appealing to patient or parent.

Are the vacuum systems battery or plug-in power?

Most mobile vacuum systems can operate on a battery but need to be plugged in to recharged

Do you know a company who can convert a negative pressure room or office?

Dr. Grant, an HVAC /air conditioner contractor could create a negative pressure room. If your office allows you to vent that room through the ceiling, you can do it inexpensively.  One client has used a Broan bathroom fan, closed all the air coming in or going out of the vents. Fan is hardwired in the ceiling and vented out the room with a “mushroom” type of cap that would keep water from coming in the vent.

The self-contained vac systems are already sold out. Any other vendors that you know of?

Vendors are producing their products as fast as possible. Such a demand. Check on potential delivery date.

Is there an estimate of how much additional cost per patient we should be expecting to invest with all these recommendations?!

This depends on the construction that you need and the age of your office. My first thought and maybe the biggest investment is adding attractive barriers between chairs. Need to solve aerosol barriers. The solution may be to take a small room and create a negative pressure room for debands. If you have that room, it is probably a $3,500-$5,000 cost. Expanded needs for PPE will be an investment for quite some time until the COVID virus is conquered.

Do you have any suggestions for those of us in urban settings where space is tighter? i.e. no parking lot, no cars?

Patient should call the office as they are approaching on foot or on bicycle. This would let you accommodate them in your “social distanced” reception room. Patients should be informed not to come more than 5-10 minutes early – you will not have enough space otherwise. If you use Lighthouse 360, or Rhinogram (possibly other systems that I am not familiar with), you can add instructions to the appointment reminder about “brushing at home”, not to arrive more than 10 minutes before appt, and other tips that will be useful.

When seeing new patients, what process would you use for their first appointment?

I would appoint a staff member as “concierge.” Concierge is notified when patient calls the office and has arrived.  Receptionist should ask what space they are in or description of car. Concierge goes to car and gets AAOIC signature from parent (hopefully only at first visit after COVID closure) and asks health questions.  Escort the child into the triage station where temperature is taken, and hands are sanitized. Escort patient to rinse with Peroxyl or Listerine before proceeding to clinic. After procedure is complete, concierge escorts patient back to parent and discusses procedures completed. Some practices have added stopping by front desk to get next appointment before returning patient to car and updating parent.  If appointment is not convenient, parent calls office to reschedule. This is a great opportunity to turn patient arrival into a marketing opportunity.

Why not have people just wait in their cars and we will text them when we are ready for them?

You can certainly do that.  You can turn this into a great marketing opportunity with a concierge visiting with mom before and after appointment.

How should you handle the public bathroom?

If the public bathroom is inside your office, then you must keep it spotless and check on it throughout the day.  If the public bathroom is in a hall or foyer, the owner of the building should handle maintenance. You should check with that landlord so that you understand how that public bathroom will be monitored and how it might be connected to your image if not monitored.

Is it possible to have our water cooler in the reception room with disposable cups?

Not unless your cups are individually wrapped. Probably small bottle of water is a better answer for the short-term.

Do we really want patients rinsing with Peroxyl and spitting out in our tooth brushing sinks considering that we are trying to prevent splatter in our offices?

Rinsing with Peroxyl or other bacteria killing mouthwash is suggested as an additional means of infection control. Sanitize the brushing station at lunch and end of day. Disinfectant should stay “wet” on sink and sink counter for at least 1-minute.

 

PPE

Do I need a shield for bonding and de-bonding? Or all appointments?

Facial shield is always useful but especially for anything that creates aerosol splatter –probably bonding, repositioning, debanding most particularly. Poor Oral hygiene level also is a concern for splatter even if only changing an archwire.

Can you recommend a good source for goggles?

Henry Schein, 3M, — Google Amazon for safety glasses for dental specialists.

If you wear a face shield – do you still have to wear goggles?

You do not have to wear a face shield and googles unless you personally decide to do so.

Are goggles ok if full facial shields are unavailable?

Yes, goggles would be an answer, but have your nose and mouth covered as well.

Are N95 masks reusable?

Manufacturers designed n95 masks for one-time use.  However, with the shortage of these masks, there are some re-use strategies.  Check these options for re-using and re-cycling n95 masks.  https://www.sages.org/n-95-re-use-instructions/

What is the difference between N95 mask and KN95 mask?

This is an answer from online summary, they are basically all the same. They stop 95% of particles >0.3 microns in size. The N95 is the USA Code, KN95 is China code, KF94 is Korea code and FFP2 is the EU code, this includes the UK

Washable vs. disposable gowns for routine appointments – i.e. wire changes, aligners and rets?

I recommend scrubs for routine appointments – use a gown overlay for debands and aerosol producing procedures.

Can washable clinic coats be worn?

Washable clinic coats can be used but a disposable overlay needs to be used when you have an aerosol procedure like a deband – otherwise your clinic coat doesn’t pass infection control standards for the remainder of the day.

Change gowns between each patient?

Change gowns between each patient depending on the contamination on the gown or jacket.

Do we need to have a long paper gown for bonding and debonding or can we have a short one?

There’s no hard rule on this but a knee length gown is covers chest and lap.

When gowns are unavailable, can we use our (laundered by a service) lab coats?

Yes, you can use a laundered lab coat, but be prepared to go through more than one per day.

Do you recommend a de-bond day – all in full gear that day versus integrating them into normal clinic days?

A number of practices are catching up with the backlog of debands by having 2 or3 deband days.  After you catch up, schedule debands on a daily basis so patient has accessibility to various days that work for appointment. Schedule the debands vertically not horizontally so there will never be 2 debands there at the same time.  Control the aerosol by keeping debands in a private room or at the end of the clinic. The end of the clinic choice should have a barrier from the next chair.

 

PATIENT HEALTH

If someone has symptoms of COVID-19, where can we refer them for free testing?
Health Department

Is “Had Fever or Felt Poorly in Last 2 Days” enough days?

That is the question that is on the AAOIC form – 2 days.  It is important to know if they are still feeling badly and you can choose the amount of days. Important to know if they are still feeling poorly, even without a fever.  If so, reschedule the appointment.  Not worth taking a chance.

 

OTHER

Can we pre-bag candy for them to take for debond? What about swag bags for bonds/new patients?

Everything should be carefully wrapped and then presented.  Family can choose how to sanitize bag and contents.

Any suggestions with patients who stayed with springs or chains?

Schedule them as an emergency and look to see if anything has taken a negative turn.