Rossouw Dental



|Policy Document |COVID 19 Risk Assessment |

|Created | 12th May 2020 |

Due to the recent Coronavirus pandemic, as a practice we have made adjustments to the day to day running of the dental surgery to ensure maximum protection of our staff, patients and any visitors to the dental practice. As such is our profession, we already implement universal precautions and maintain a high standard of cross infection control, however, in response to the recent crisis the following adjustments have been made according to research and guidelines carried out by the British Dental Association and the British Association for Private Dentists to meet all government standards set out.

Prior to the coronavirus pandemic we carried out our infection control within the practice as per the HTM 01-05 guidelines, below is a summary of key points within our existing infection prevention and control policy;

• The patient treatment area and items of equipment was cleaned after every session using disinfectant spray and disposable wipes even if the area appears uncontaminated. This will include work surfaces, dental chair, inspection light and handles, hand controls, delivery units, spittoons, aspirators and, if used, x-ray units and controls. Other equipment that may have become contaminated must also be cleaned.

• In addition, cupboard doors, other exposed surfaces (such as dental inspection light fittings) and floor surfaces with the surgery was always cleaned daily.

• Water bottles fitted to the chair were always filled using distilled water only.

• DUWLs should be flushed for at least two minutes after any significant period when they have not been used (for example, after lunch breaks).

• Waterlines are treated by an Adec ICX tablet in each water bottle. According to expert recommendation, an Adec ICX tablet is placed inside the bottles during each refill to maintain water quality and aid in preventing biofilm in DUWLs.

• PPE includes protective clothing, disposable clinical gloves, plastic disposable aprons, face masks, and eye protection. In addition, heavy duty gloves are worn when handling and manually cleaning contaminated instruments. Footwear are fully enclosed and in good order.

• At the end of each patient treatment, instruments are transferred to the decontamination area for cleaning.

• Where instruments are cleaned manually, the practice policy for manual cleaning are followed. Full PPE are worn during cleaning including, heavy duty gloves, apron, face mask and eye protection.

• Zoning of sterile and unsterile areas are clearly marked within surgeries and the decontamination room.

We have identified potential higher risks of transmission whilst undergoing these standard operating procedures and therefore have put measures in place to minimize these risks, please see table below. We have also extended cleaning protocols to the surrounding environment areas, such as waiting room/reception desk/staff and patient toilets.

We identified risk areas as:

1) Reception staff & patients whilst dealing with patients at the reception desk.

2) Patients contaminating each other in the waiting room

3) Patients entering the practice with virus contaminated hands

4) Patients entering the practice with COVID-19 like symptoms

5) Staff working with COVID-19 like symptoms

6) Virus present in patient’s saliva, causing virus contaminated aerosol

7) Virus contamination of work surfaces and the air in the surgery during treatment

8) Staff being contaminated with the virus during treatments

9) Toilets being contaminated with COVID-19 virus by patients and staff

The following practices are ways in which we aim to eliminate the risk of transmission of COVID-19 in the dental setting as mentioned above;

|New Measure |Benefit to whom |How it will help prevent transmission of COVID-19 |

|Asking patients to disclose any potential symptoms |Dentist, hygienist, dental nurse, patients and |We already have a patient confirmation call service in place at reception. Reception have |

| |staff |been asked that during this time they also advise the patient that if they or anyone in |

| | |their household has had any of the following symptoms; dry, persistent cough, high |

| | |temperature/fever, they will be asked to cancel and rearrange their appointment for a |

| | |minimum of 14 days time. Patients who are COVID-19 positive or have symptoms and are in |

| | |pain, will be telephone triaged and provided with advice, antimicrobials and analgesics. |

|Infrared thermal imaging camera |Receptionist, patient, dentist, dental nurse & |This is a contact free device which will enable us to check patients for any raised |

| |hygienist |temperatures as soon as they arrive at the practice, and if so they will be asked to delay|

| | |treatment for a minimum 14 day period and advised to return home and adhere to all |

| | |government guidelines in regards to isolation. It will also be able to be used on staff |

| | |daily before they begin work, again any staff displaying raised temperatures will be asked|

| | |to go home and follow government guidelines. |

|Perspex screening at reception |Patient & reception staff |This is a method which has been adopted by many other businesses across various sectors in|

| | |the country, for example within supermarket checkouts. It will aid in the prevention of |

| | |transmission of the virus in general areas within the surgery which are not "surgical" |

| | |areas, and are in regular use by the public. This will aid in protecting our reception |

| | |staff and the patient during booking appointments and/or taking payments. |

|Use of surgical face masks when on reception |Receptionist & patient |Surgical face masks will help protect reception staff and patients/visitors entering the |

| | |practice from transmission of the virus. This PPE will be made available to all reception |

| | |staff. |

|Social distancing parameters and a minimal contact |Dentist, hygienist, dental nurse, patient & |The practice has been altered to accommodate the recommended 2m social distancing. We have|

|patient flow |staff |done this by making sure chairs within the waiting room are at an acceptable distance and |

| | |detailed marking on the floor of where patients should wait should they need to. However, |

| | |we are actively reducing the need for any patients to be waiting in the waiting room by |

| | |booking the day accordingly to allow enough time between appointments that there will not |

| | |be a back to back system in place. Patients will also be encouraged to call the practice |

| | |to arrange appointments/payments so there will also be minimal contact required at |

| | |reception. Should a situation arise and it looks as though appointments will run into one |

| | |another, reception have been advised to manage the situation by calling patients to delay |

| | |or asking them to remain in their cars until they are asked to enter the building. |

|Asking patients to wash and sanitize hands |Dentist, hygienist, dental nurse, patients & |All patients will be asked to wash and sanitize their hands on arrival at the practice to |

| |staff |reduce the risk of transmission within public areas of the surgery, for example the |

| | |waiting room. We have two toilets in the practice. Our disabled access toilet will only be|

| | |used by our patients, and the other one is for the staff. |

|All internal doors in the practice as well as all the |Dentist, hygienist, dental nurse, patients & |This allows all staff and patients to push doors open and close with their arms or bodies,|

|cabinetry in the surgeries are fitted with push latch |staff |without having to touch it with their hands. If they need to lock the toilet door when |

|mechanisms. | |having to use the toilet, we will ask them to turn the lock with a tissue, but our |

| | |reception staff will then disinfect all areas in the toilet which can possible be |

| | |touched, as soon as the patients leaves the room. |

| | | |

|The use of a hypochlorous acid pre-treatment rinse |Dentist, hygienist, dental nurse and patient |This will aid in minimizing transmission from patient to dentist/dental nurse. |

| | |Hypochlorous acid provides a safe, and effective method of reducing oral bacterial and |

| | |viral load prior to dental treatment. There are no known drug interactions or safety |

| | |precautions unlike other oxidizing mouthwashes. |

|Purchase of air purification units |Dentist, hygienist, dental nurse, patient & |An air purification unit will assist in minimizing the risk of transmission of COVID-19 |

| |reception staff |through airborne pathogens which are potentially generated during AGPs. Although it cannot|

| | |be considered an effective method if used solely on it's own, when used in addition to |

| | |staggered AGP allotted times throughout the day and efficient disinfectant and |

| | |cross-contamination control, it will have a positive impact on reducing the risk of the |

| | |transmission of the virus. |

| | |These units will be installed in both surgeries, the waiting room and the patient toilets.|

|Adequate high volume suction |Dentist, hygienist, dental nurse and patient |High volume suction draws a high volume of air away from the oral cavity during AGPs |

| | |therefore also reducing the amount of aerosol and splatter. This is therefore an effective|

| | |measure to reduce risk of transmission, especially when used in addition to the rubber |

| | |dam, which as stated previously will be used for every patient. |

|Purchase of an extra-oral dental vacuum system |Dentist, hygienist, dental nurse & patient |This is a precautionary system in place to collect any aerosol and splatter which is |

| | |missed by the high volume intra-oral suction. This provides an additional layer of |

| | |protection to the dental team and patient by reducing the aerosol. As it collects the |

| | |dental aerosol at source, it also reduces the risk of contamination of dental surfaces |

| | |within the surgery. |

|The use of a rubber dam for every AGP procedure |Dentist, hygienist, dental nurse and patient |This will help maintain a "clear/dry" work space which will in turn aid in reducing the |

| | |amount of potentially infectious aerosol produced during AGP procedures by assisting in |

| | |keeping saliva exposure at a minimal level to the dentist/dental nurse. |

|The use of FFP3 face masks |Dentist, hygienist, dental nurse and patient. |This is a higher grade of mask which will prevent transmission of the virus during AGPs |

| | |(aerosol generating procedures). Although the scientific evidence suggests it provides |

| | |only little more protection than a regular surgical face mask used during dental |

| | |procedures, it will effectively perform the role of reducing any transmission of COVID-19 |

| | |between patient to staff or vice versa. |

|Surgical gowns worn for every AGP patient |Dentist, hygienist, dental nurse, patient & |Enough surgical gowns will be provided for staff to wear for all AGP procedures, to reduce|

| |staff |the risk of transmission from the surgery to other areas of the practice by contaminated |

| | |staff uniforms. This will include hygiene and any deep root scaling appointments with the |

| | |hygienist. |

|The fix mask rubber frame to fit over standard surgical |Dentist, hygienist, dental nurse, patient |I have made rubber frames to fit over the standard surgical masks used pre-Covid, to |

|masks | |ensure a proper seal. . These will be used for non-AGP s [pic] |

|Glass keyboard for surgery |Dentist, hygienist, dental nurse, patient |I have purchased a glass keyboard for the surgery to do my notes on, which is water |

| | |resistant, to enable us to properly disinfect it between patients. |

|Surgery cleaning at the end of the day |Dentist, hygienist, dental nurse, patient & |Our cleaner has always come in every night to do a deep clean of the surgery. All hard |

| |staff |surfaces and floors are cleaned and disinfected as well as toilets, the kitchen and |

| | |reception. All clinical surfaces in the surgeries are cleaned by the nurses before we |

| | |leave. I would also like to note that I have ceiling to floor mirrors fitted on all the |

| | |walls in the hallway and all the internal doors are covered with glass, which makes it |

| | |very easy to wash and disinfectant all surfaces which patients may touch. All surgery |

| | |cabinetry are also fitted with glass doors and push latch mechanisms, which enables |

| | |clinical staff to never have to touch the doors and drawers to open them |

During non aerosol generating procedures, the dental team will wear PPE inclusive of; surgical face masks, visors, scrubs, plastic aprons and gloves. During aerosol generating procedure the PPE will be upgraded to be inclusive of; long sleeve surgical gowns, gloves, FFP3 face masks and visors.

These new measures put in place, in addition to our existing universal precautions taken such as; full PPE (visors/masks/gloves/gowns/aprons), sterlisation of instruments, disinfectant of DUWLs daily, disinfectant of suction daily and clearly zoned areas within the surgery, will offer a very high level of protection to the dental team and patients. Therefore with all of these measures in place the risk of transmission is deemed to be almost completely eliminated.

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The Fire Station

High Street

Seal

Sevenoaks

TN15 0AF

01732 762034

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