Seven Questions on Infection Prevention and Control in Dentistry

As we approach another COVID-19 winter in the United States, the health care industry is bracing itself for the possibility of another wave of infections. In preparation, in late September, the CDC issued new infection prevention and control updates, providing guidance around topics including testing, exposure, and universal personal protective equipment (PPE).

A recent CareQuest Institute webinar, produced in collaboration with the Organization for Safety, Asepsis and Prevention (OSAP), the only dental membership association for oral health care professionals that focuses exclusively on dental infection prevention and patient and provider safety, explored the updates and offered advice on the topic. Kathy Eklund, RDH, MHP, director of occupational health and safety and Forsyth research subject & patient safety advocate at The Forsyth Institute, spoke on the webinar, discussing the latest guidance and how it pertains to dental professionals.

“As we continue to live with COVID-19, it’s important that the standard precautions are supplemented with the current CDC infection control guidance for health care professionals,” Eklund said. “And this includes dental health care professionals.”

During the webinar, which drew more than 600 participants from the oral health industry, Eklund walked through the latest information on standard infection control, prevention, and transmission-based precautions. She also shared the importance of designating someone to monitor the latest in guidelines and community transmission levels for your practice.

Participants had several questions as the hour-long webinar came to a close, offering a glimpse on what is most pressing on oral health providers’ minds on the topic of infection prevention and control:

1. Who needs to be wearing a mask in the dental office? Can we wear the same mask all day?

Face coverings for source control need to be worn by everyone. That means anyone coming through the door — personnel, patients, visitors, and vendors. Regardless of people’s vaccination status, source control and face coverings should be worn at all times, until there is a change in guidance. If you’re wearing a mask as source control and you’re not delivering care, you can wear it as long as it’s intact. But if you’re delivering patient care, a face mask needs to be changed between each patient. Also, if you’re wearing a respirator for aerosol generating procedures, the respirator also needs to be changed between each patient.

2. What are the recommendations for using the high-volume evacuation?

If you’re doing anything that’s generating any aerosol, high-volume evacuation is important to help reduce the aerosolization. The National Institute of Occupational Safety and Health (NIOSH) conducted a research study last year looking at comparing different high-volume evacuations — intraoral, not extraoral — and found that they were pretty similar in reducing the amount of aerosols.

3. Can you discuss HEPA filter placement? Also, what is classified as an appropriate type of HEPA filter?

There are different types of air filtration, including HEPA filters. Each of these has what is called a clean air delivery rate. When you have a higher clean air delivery rate, that means the filter is going to circulate more of the air through it. So, if you’re purchasing these, you need to ask yourself: Where are you putting it? What size do you need? What clean air delivery rate do you need? Are you putting it in a broad general area, or are you putting it in an isolated closed operatory? You can explore more here.

4. What is the best way for someone in an office to garner support from their leadership to implement some of these recommendations that we’re hearing about today?

It’s always all about communication. Everybody wants to deliver safe and quality care, but you want to make sure that patients and personnel are safe in the process. So, it depends upon the size of your setting. If it’s a private practice setting, you want to have someone who’s been given the responsibility and the authority to be on top of all this information, to be able to review the policies and procedure, to do education and training, and be given the time to do it. In larger practices, like DSOs, you may have someone at the higher level who’s in charge, but then you have to have local site people hold the responsibility and do the monitoring.

5. Should we be reporting if we think we might have been exposed to COVID-19? Should we be reporting to our employer if we might have been exposed but we’re not experiencing symptoms? What do we require from patients?

These questions tie into the recommendations to have a protocol. That’s why you need to have somebody who is on top of this. On September 23, some of the guidance changed for health care personnel, so you need to have someone making sure that your policies and procedures are consistent with the guidance. I use the example of exposure. If you’re fully protected, but you live in a household where two family members have COVID-19 and you’ve been in close contact with them, that’s when having specific policies and procedures around testing and monitoring become important.

6. Who in the dental office do you feel is best suited to be the individual who keeps up with the current guidelines?

It can be anyone, but they have to have the time, the education, and the training. Whoever it is, they should have administrative support for that education and training, and for the time it takes to remain current. They should also be able to address things as they’re needed or bring people together to talk about it.

7. If somebody wants to take the lead in their office and be the person that helps bring all of this together, is OSAP a good resource for them to turn to?

Yes, absolutely. These are some other helpful resources:

• Dental Infection Control by OSAP, the Dental Assisting National Board, and the DALE Foundation has two certification programs: Dental Infection Prevention and Control® and the Dental Industry Specialist in Infection Prevention and Control®.
• OSAP Dental Infection Control Bootcamp is an intense three-day program for infection prevention and control in dentistry. There are speakers from the CDC, FDA, NIOSH, and others who participate in this. It’ll be held in person in Atlanta in January 2023, but for those of you who can’t or don't want to travel, you can do the program and stream it online from February 13 through April 14.
• CDC Foundations: Building the Safest Dental Visit is a three-part education and training that was developed about a year ago. It gives ADA CERP credits.