Infection control & Covid-19 considerations in the Dental Laboratory. By Andrea Johnson

Has Covid-19 had much of an effect on how we run and operate our laboratories? Have our infection control processes had to change dramatically?

Surprisingly not really, as we are already working in an environment where we need to be aware and take suitable precautions with regards to personal safety and cross infection control. So what do we need to think about?

STAFF CONSIDERATIONS We need to think about the health implications of our working environment and the conditions in place for your staff, yourself and the resulting impact this can have on your families etc

A good precaution with regards to cross infection, Covid-19 or not, is to change into and out of your work uniform at work. When you have finished with it place your contaminated uniform into the washable bag and then pop the whole bag of clothes (including the bag) into the washer to decontaminate them when arriving home.

WORK RELATED STRESS & MENTAL HEALTH COUNSELLING

What is stress? HSE defines stress as ‘the adverse reaction people have to excessive pressures or other types of demand placed on them’.

Stress is not an illness but it can make you ill. Recognising the signs of stress will help employers to take steps to stop, lower and manage stress in their workplace.

Employees feel stress when they can’t cope with pressures and other issues. Employers should match demands to employees’ skills and knowledge. For example, employees can get stressed if they feel they don’t have the skills or time to meet tight deadlines. Providing planning, training and support can reduce pressure and bring stress levels down.

INFECTION CONTROL AND COVID-19 CONSIDERATIONS IN THE DENTAL LABORATORY

By Andrea Johnson

Stress affects people differently – what stresses one person may not affect another. Factors like skills and experience, age or disability may all affect whether an employee can cope.

There are six main areas of work design which can affect stress levels. You should manage these properly. They are:

• Demands • Control • Support • Relationships • Role • Change

Employers should assess the risks in these areas to manage stress in the workplace.

How to help The earlier a problem is tackled the less impact it will have. If you think that an employee is having problems, encourage them to talk to someone, whether it is their line manager, trade union representative, GP or their occupational health team. (Health & Safety Executive (HSE), 2020)

Also, have numbers of helplines and counselors on display and easily available for staff needing professional support.

HEALTH RISK ASSESSMENTS OF STAFF It is important to carry out regular health risk assessments with your staff and even more so in the current climate. This will not only allow you to make sure that you have the best possible precautions and workplace environment for the safety of your staff but will also serve to reassure your staff that you are taking their personal wellbeing into account and you can help them understand and contribute any ideas to a safer way of working for them.

Training of staff in new protocols It is important that if you have put any new measures into place either because of Covid or any other reason, that you fully inform and train all your relevant staff in these new protocols, try to remember those that have been off sick, annual leave, maternity and new starters may not be as up to date as the rest of your staff so they will need a back to work refresher if anything has changed in their working environment or your expectations of them.

Due to covid-19 there have been many changes in the guidance for our profession, some of these in the early days of the pandemic were changing very frequently as we learned more and more about how the virus is transmitted and its effects on the human body. Fortunately, many of these changes have reverted back to their original state but some have changed for the foreseeable future. For this reason, please make sure you regularly check for updates with the following:

• Health and Safety Executive

• Medicine and Healthcare Regulatory Authority (MHRA) - Medical Device Regulations (MDR)

• Public Health England

• Government guidelines

• General Dental council

• Chief Dental Officer

• Insurance – does it cover you for all your activities and any Covid-19/pandemic issues?

Lab layout Social distancing is now very important to protect your staff, it may help to have suitable floor markings as a reminder to staff. Maybe moving or decommissioning of some workstations or areas will help to facilitate this.

You may also have to stagger breaks and start/finish times to allow for maximum safe capacity whilst still being able to maintain a safe social distance from each other.

Hand washing – consider placing hand washing stations at entrances and exits or clear unobstructed pathways to them.

Public/Patient/Visitor/delivery access – depending on your space and lab layout you may have to consider using screens in areas where you may get occasional visitors, delivery drivers etc. Make sure that you also apply Floor markings, hand gels, laminated posters in these areas to make it clear to any entering your laboratory what you expect from them.

If it is at all possible provide a suitable area/ staff room where staff can change into and out of their work clothes and wash their hands etc after changing.

LABORATORY ENVIRONMENT & EQUIPMENT

Air conditioning/ventilation General ventilation

Employers must, by law, ensure an adequate supply of fresh air in the workplace and this has not changed.

Good ventilation can help reduce the risk of spreading coronavirus, so focus on improving general ventilation, preferably through fresh air or mechanical systems.

Where possible, consider ways to maintain and increase the supply of fresh air, for example, by opening windows and doors (unless fire doors).

Also consider if you can improve the circulation of outside air and prevent pockets of stagnant air in occupied spaces. You can do this by using ceiling fans or desk fans for example, provided good ventilation is maintained.

The risk of transmission through the use of ceiling and desk fans is extremely low providing there is good ventilation in the area it is being used, preferably provided by fresh air.

Air conditioning The risk of air conditioning spreading coronavirus (COVID-19) in the workplace is extremely low as long as there is an adequate supply of fresh air and ventilation.

You can continue using most types of air conditioning system as normal. But if you use a centralised ventilations system that removes and circulates air to different rooms it is recommended that you turn off recirculation and use a fresh air supply.

You do not need to adjust air conditioning systems that mix some of the extracted air with fresh air and return it to the room as this increases the fresh air ventilation rate. Also, you do not need to adjust systems in individual rooms or portable units as these operate on 100% recirculation. You should

still however maintain a good supply of fresh air ventilation in the room.

If you’re unsure, ask the advice of your heating ventilation and air conditioning (HVAC) engineer or adviser. Remove nonessential equipment especially from ‘dirty’ areas (Health & Safety Executive (HSE), 2020)

PPE Under the Health and Safety at Work Act that PPE should be worn as standard – including face protection due to the risk of splash or injury to the face in the manufacture process.

FFP2/3 masks – these I recommend for use in any procedure where you are handling a potentially contaminated item and causing spatter/aerosols such as grinding or polishing repairs or used/worn patient appliances. If wearing an FFP2/3 for these reasons it is highly recommended to get fit tested to make sure that the mask is giving you the full protection for your face shape.

Another great precaution for not only your safety but also to keep the mess and dust down in your working environment is to use a grinding box for repairs.

When Polishing up (repairs) – spatter etc – use lab coat, gloves, plastic apron, goggles/ visor. Use pan liner if possible, use fresh pumice and change after each appliance, dispose in clinical waste. Clean down after each use and dispose of aprons and gloves.

INFECTION CONTROL The Decontamination of Medical Devices Regulations and the Health and Social Care Act 2008 apply here in that Standard precautions apply when handling and disinfecting incoming work- impressions and repairs, try ins etc

Decontamination of instruments, burs, brushes, polishing lathes, hydroflasks should be completed regularly – in fact, straight away if known to have been used on a contaminated appliance.

Cleaning rotas should be in place for:

• Thorough cleaning down at the end of each day • Throughout the day – cleaning touchpoints such as door handles, handpieces/ instruments, counter tops, phones (and mobiles), keyboards, computer mice, kettle, microwave, fridge door, chairs.

BIBLIOGRAPHY Health & Safety Executive (HSE). (2020). Air conditioning and ventilation during the coronavirus outbreak. Retrieved from Health & Safety Executive: https://www.hse.gov.uk/coronavirus/equipment-andmachinery/air-conditioning-and-ventilation.htm Health & Safety Executive (HSE). (2020). Work-related stress and how to tackle it. Retrieved from Health & Safety Executive: https://www.hse.gov.uk/stress/ what-to-do.htm

l Jan qualified as a dentist in 1988 and worked in the hospital service and then general practice. She was a practice owner for 17 years and worked as an Advisor with Denplan. Jan now works helping dental businesses with their marketing and business strategy and heads up the Social Media Academy at Rose & Co.

Web: www.roseand.co Email: jan@roseand.co Facebook: Jan ClarkeTaplin Twitter: @JanetLClarke Instagram: janlclarkeacademy LinkedIn: Jan Clarke BDS FDSRCPS

WHERE TO START WITH MARKETING POST-LOCKDOWN

Last time I talked about building relationships with your clients during this quieter post-lockdown period, spending time on strengthening these connections and finding out how you can help. I thought I could maybe expand on this and discuss some points to help you with your marketing and increasing your work load.

With dental practices now opening up a little bit more and starting to carry out some AGP I am hopeful that some of you are starting if not to return to normal then starting to build up business again. You may have had staff on furlough and will be having to make decisions about whether to continue or possibly make redundancies. Now is the time to take a good look at your business and examine how you can ease the burden of these decisions before end of furlough deadlines.

In my experience, dealing with our clients, there now certainly seems to be an increased request for cosmetic work and this bodes well for your recovery. As I said last time a lot of this may be teeth straightening and aligner requests but all too often these patients’ cosmetic requests are not simple and it's not always so easy just to fit aligners, they often require far more involved work including fillings, crowns, bridges, implants, and veneers.

The million dollar question is what can you do now to help bring some of this work to you? I mentioned last time about building relationships and being amenable to new clients and existing clients, not being the cheapest not being the quickest, but being helpful and being there for your clients.

THE FIRST THING TO DO IS TO : 1. Make contact with your existing clients Why not just pick up the phone and call your clients to have a chat? Dental practices are still quieter with dentists having to wait between patients waiting for fallow times and therefore more likely to be able to accept your call. Ask them what problems they are facing and find out how you can help them. By strengthening this professional bond and building connection you are more likely to find you will be the first technician they will think of when they prep for a crown. Try not to tell them about your fantastic offer but concentrate on building trust and rapport. People are more likely to buy from people they know and trust and connect with. Building rapport is as important for you with your dental practice clients as it is for the dentist with their patient.

2. Consider also spend some time revisiting your customer journey. How is your business perceived by your dental practices? How is your pickup service (if you have one) ? Can you make it easier? Can you make it more flexible or as simple as you can? How about logging in lab work is it as easy as it can be can you make it simpler maybe download lab sheets from the website? Is your billing as transparent as possible? Are your clients happy with and understand the cost that they are been asked to pay in the same ways dentists have to be transparent with their patients?

3. Look at your business brand, does it have a clear coherent message? It is time to look at your website and digital offering including your social media marketing. There is no doubt that your website is your biggest marketing tool and most likely your largest spend. If you already have a website, when was it last updated? Can you find it in a search engine? Websites need to be kept healthy with regular updates. Most websites built on the WordPress theme are easy to update with little expense, you may be even able to do this but gone are the days where a homemade put together website is acceptable people expect a little bit more sophistication now. If you haven’t already invested in a website now is the time to consider this. A new website need not cost you a fortune. You do not need a vast 40 page website to start. Think about your presence and keep your website simple to start. Just a few essential pages can start you off but it is essential to talk to your ideal client when writing the copy for your website. Ensure your website is appearing in search engines and one easy way to update your website regularly and keep Google happy is to add a Blog page to your website. If you have an existing site and haven’t already started a blog use this time to do this. You could write about a case study in your blog and even consider a collaborative approach with a dental practice whereby you maybe do a case study of a patient you’ve been involved with. This not only strengthens your links but helps them provide content for their website too. A win win! A word of warning though, change the copy slightly for each website because Google penalises duplicated content. Utilising a blog gives a dentist a really good way of being able to see the sort of work you do and how it is implemented.

Now let's look at your social media presence, have you got a social media presence? Perhaps you don't think you need one and I do realise that not many dental technicians are on social media but I think it’s a great place to be. On social media you can regularly post content to talk about your business to show a human face to your business and your team. It doesn’t always have to be about dentistry and cases or the work you do, it’s can be about the people that work there, in the same way dental patients like to see their dental practice staff and personnel and what's happening in their lives. The most obvious place to be is Facebook and Instagram. I can spend more time next month discussing this further. In the meantime why not revisit Facebook and have a look around, see what other technicians may be posting.

I wish you all the best during this difficult period of transition and as usual should any of you require a face to face chat via Zoom with some pointers for your marketing I am more than happy to offer these free of charge, please just email and I will set up a call.