KEEP COVID SAFE Care for yourself and provide better care of your patients

Margie Steffens OAM outlines some best practices to observe when working through this pandemic – and some that we should observe at all times

2020, EXTRAORDINARY TIMES – confusing, uncertain, and changeable, but a time to reflect on where we sit in this world. More importantly, how we respond now sets us up for the future.

As chair of the Special Needs Special Interests Group (SIG), I work with some exceptional people at the forefront of infection control (in particular Dr Sharon Liberali) who are constantly reviewing and making recommendations based on current knowledge.

Keep in mind that we are dealing with the ever-changing landscape surrounding the unpredicatble behaviour of COVID-19 and indeed the behaviour of viruses in general. Without wanting to over simplify concerns, remember that knowledge is power; and that taking the time to quietly review the good literature – written by respected and knowledgeable authors – can help us to dispel the fear of the unknown.

Social media, and the media in general, can further cause us disquiet and increase our anxiety. We tend to grasp at the first thing that hits our inbox, and it is so easy to respond to that information as it may have been sent by a wellmeaning friend.

I have been asked to share some information that I trust will give some guidance and help you to discern and gain confidence as the respected health care professional that you are!

Managing patients

1. Screening will possibly become the norm. The basic checks regarding recent health history, travel and possible contacts is a sensible approach. How often do patients ring in if they have a cold or tummy bug to check if it is OK to come in? We should be rescheduling people that are unwell as these viruses are virulent and easily spread.

2.If you are working in hot spots or with a suspected case, the questions are of utmost importance and if people are awaiting results from testing then defer their treatment.

3.If you absolutely must treat someone then refer to the additional precautions outlined in this feature that include the wearing of properly fitted (P2)N95 masks, gowns and the provision of isolation areas. However, it is not recommended unless it is emergency care, and then the recommendations about not causing any aerosols apply.

4.If your patients are frail elderly, people with autoimmune disease, or generally poor health, and your area has been deemed a “high risk” area then you must follow the advice guidelines from your state and territory’s guidelines. If treatment advice has escalated to Level 2 it is not recommended to treat these folk and, of course, Level 3 is emergency only. You must adhere to these recommendations as they come from the Dental Board. To breach them you risk a fine and notifications plus it is likely that your indemnifier would not cover you if there was an incident.

5.Upon entering the operatory ensure that patients have washed their hands with soap and water or use an alcohol gel. Also, perform a pre-treatment rinse with Hydrogen Peroxide or Chlorhexidine. When we consider that we are always working with moisture present – saliva, aerosol, coughing, talking at close proximity in the clinic etc – the use of a pre-op mouth rinse is not a bad work practice to adopt.

6.Extend appointment times. Rationalise with your dentist about the importance of the practice reputation and maintaining optimal patient quality care. Is it not more sensible to reduce patient numbers and minimise risks? The alternative could mean having to close the practice for weeks and incurring a significant loss of revenue as well as putting the public and the practice at risk.

7. Reappoint your patients if they have viruses. Herpes viruses, such as cold sores, are easily spread if they are still at blister stage or the early healing stage.

Keeping yourself safe

1. Remember that you are equally as important as your patients and your health matters too. All of the aforementioned practices form part of keeping yourself safe.

2.Ensure that if you are unwell, or more vulnerable to ill health and have preexisting autoimmune conditions, and are working in high risk areas then you are advised to not put yourself in danger by treating a patient who is a possible transmission risk. Refer to item 4 of 'Managing your patients'.

3.Take time for self-care, exercise, sleep, good nutrition, and meditation. Lyn Carman’s 21 days of abundance on the DHAA Facebook page is a great guide and simply following the meditation section is a good starting place.

4.'Gratitude' is such an uplifting word – I say it every day and it gets me through some very tough times! Spend time with your family, friends, and colleagues; appreciate what we do have rather than what we don’t.

5.If you are finding yourself constantly anxious and need to talk there is the DHAA Peer Support Service (read more on page 22). This new initiative allows you to communicate with other people who have acquired skills in support systems.

6.Communicate with your employer honestly and without blame. Present any concerns in a manner that expresses that your primary interest is the patient’s well-being, the reputation of the practice and the care for all your co-workers. Most people will generally see reason.

7. Does your practice have a COVID-Safe plan in place? The ADA website has clear and practical information for all dental practitioners to access. 8.If you are unwell – Stay Home!

“To contravene these regulations is an offence and can incur a fine and can have serious consequences for the practitioner”

PPE and reinforcing additional health information:

1. Masks. The same recommendations remain – P2/N95 if you are working in a hotspot with a possible 'known' case.

2.L3 masks are sufficient for all of us and the same recommendations remain with regard to changing after every patient or should you need to leave the surgical space. MASKS SHOULD NEVER BE WORN “AS A NECKLACE” REMOVE COMPLETELY AND REPLACE!

3.If you are required to wear a P2/ N95 mask the questions remain. Are you working with a known case? Are you, or your patient, immune compromised? Are you working in a hotspot? Are you creating aerosols as part of a necessary treatment on a possible, or known, case and in particular is this in a hotspot? Are you unwell yourself and if not then should you actually be working?

4.Consider why we wear gowns. If you are working in a hotspot or with a patient with questionable status or if it is to prevent transmission in a high risk area or situation then you must wear one and change it after each patient.

5. If you are pregnant or have other health conditions then talk with your GP or specialist. We do not know enough about the behaviour of the virus to make a generalised statement.

6. We are unable to give absolutes at this time regarding precise transmission and how the virus is behaving, and it is ill-advised for anyone to make blanket statements. Keep communication open with your dentist/ADA and keep watching for changes from the Department of Health in your state or territory.

7. What we do know is that if we follow infection control protocols as a guiding principle – wash your hands, don’t touch any surface, your face etc., or other people if you have coughed, sneezed, been to the toilet or you are feeling unwell! Follow all of the things that we know about best practice; this will minimise harm and reduce risks.

8. Most importantly – we should adhere to good infection control standards at all times!

Guidelines and regulations – These regulations are set down by the Regulator and not by the associations. To contravene these regulations is an offence and can incur a fine and can have serious consequences for the practitioner.

The regulations are there to protect us all – the dental practitioner, the staff at the practice and the public, our patients, our family and our friends.

Keep safe and continue to learn, grow as a clinician and a caring confident human being.

I may be contacted via email – margie. steffens@adelaide.edu.au or via the DHAA and our CEO Bill Suen should you have any further concerns or queries.