Our Response to COVID-19
Training and Educating Our Team
Our office has been transformed to make our work environment as safe as possible to treat periodontal disease. I am incredibly proud of the effort my team and I have made to learn as much as possible about preventing transmission of the coronavirus. The following is a brief list of the work we have done to date:
· We had refresher training in proper hand washing techniques. This may seem basic; however, it is the most important thing we can do to prevent spread of the virus. Consequently, we have spent a lot of time ensuring that our team does it well and often, especially before and after every patient encounter.
· We practiced the appropriate use of personal protective equipment (PPE) prior to caring for a patient to prevent contamination.
· Team members who are not feeling well are asked to stay home.
· All team members have their temperature taken at the beginning of every day and we will immediately dismiss anyone with a fever (100.2 F and above).
· We limit the numbers of team providing their care to facilitate social distancing within the office and among team members.
· We have created a specific checklist of recommendation for our team to follow so that they arrive to work healthy and go home to their families without worry. (see Checklist of Recommendations for Our Team)
Recommendations for Our Team
Before coming to work our entire team is honoring the following guidelines…
· Take temperature (do not go in to work if you or any other family member are experiencing symptoms; cough, sore throat, fever…etc.)
· Remove watch and rings and leave at home.
· Tie hair up, keep nails short.
· Avoid extra accessories.
· Place phone in a Ziplock bag that you will discard at the end of the day. No cell phone use at work.
· If bringing a lunch, place in disposable wrapping.
Bring work clothes in a washable bag (i.e. pillow case).
They have practiced the appropriate use of personal protective equipment (PPE) prior to caring for a patient to prevent contamination.
Upon arrival at work, our team…
· changes into scrubs and work shoes (preferably plastic and wipeable) as soon as you arrive (shoe covers are on their way!).
· Uses PPE as appropriate (N95 masks, disposable gowns, head covering, face shield)
· Leaves all clutter (pens, phones, etc.) outside of patient op rooms
· We discourage workers from using other workers phones, desks, offices and other work tools and equipment when possible.
After work, our team…
· Washes hands and arms.
· Removes scrubs and place in washable bag or leave at work.
· Washes hands and put clean clothes on.
· Sanitizes phone, glasses, etc.
· Washes hands again
Upon arriving home, our team…
· Removes shoes and clothes
· Wash clothes/scrubs in washing machine with detergent and hot water
· Shower immediately with soap and water before touching anything (including loved ones)
Recommendations for our Patients
Please note: We are lightening our schedule to see one patient at a time. As a result, the entire team is dedicated to preparing for your appointment. This time is reserved exclusively for you. All appointments are considered confirmed when scheduled.
Before you arrive for your appointment, we will…
· Ask you to call MacKenzie to reschedule appointment if you have had symptoms of infection within the last two weeks (dry cough, sore throat or fever).
· We ask that you call the office at (916) 446-9100 or text when you arrive and wait in your car. A team member will greet you in the parking area.
· As rapid testing evolves, we may ask you to arrive early enough to administer a screening test before leaving your vehicle.
To honor social distancing guidelines while in the office, we will…
· prioritize high risk patients (immune compromised) or patients 60 years of age or better with early morning appointments.
· Extent appointment times to minimize or eliminate patient to patient contacts. (A maximum of two patients at a time).
· utilize a “virtual waiting room”: patients and guests are asked to wait in their car or outside the office where they can be contacted by mobile phone at their appointment time.
Safety measures taken upon arrival you will notice…
· One point of entry to the office. Please park in the garage and use the garage entrance.
· Building entrance and suite door will be propped open to eliminate contact.
· Visual alerts (e.g., signs, posters) will be placed at the entrance door advising patients of the Coronavirus risk and advising them not to enter the facility when ill.
· Masks and tissues are made accessible immediately upon entry and instructions are provided on how to use tissues to cover nose and mouth when coughing or sneezing, to dispose of tissues and contaminated items in waste receptacles.
· supplies such as alcohol-based hand rub (ABHR) with 60-95% alcohol, tissues and no-touch receptacles for disposal, at the entrance, in waiting rooms and at front desk.
ALL these measures can help to prevent transmission to others.
Measures Upon Arrival
· Immediately escorted to a hand washing station
· Asked to rinse with 1% hydrogen peroxide for 30 seconds before each appointment
· Escorted into an examination room as quickly as possible upon arrival to avoid lingering in front office.
· Asked about the presence of symptoms of a respiratory infection and history of travel or contact with possible Corona Virus patients.
· Assessed for respiratory symptoms and fever (with a non-contact digital infrared forehead thermometer) and they will be asked to sign a health declaration form.
· If fever temperature of 100.2 degrees F or higher or respiratory symptoms are present, they will be advised to seek medical treatment and their visit will be rescheduled.
· As testing for the virus becomes more available, we will be incorporating this added benefit to screen patients.
Measures Taken Upon Patient Entry to the Clinic
· If an examination room is not readily available, ensure social distancing in the waiting room by placing seating a minimum of 6 feet apart.
· Remove all clutter and anything that is not easily disinfected from the waiting room (magazines, area rugs, pillows, toys, etc)
· Cover all furniture which cannot be disinfected with disposable covers (including chairs and couches) which will be replaced after each patient
· Frequent wipe down of waiting rooms, bathrooms, door handles, tables, light switches, computers…etc.
Reception Room and Front Desk Safety Measures
· Headphone use is encouraged, so hands are free and only one person uses it.
· Place air-handling systems (with appropriate filtration, exchange rate, etc.)
Protocols of the Clinical Team
We adhere to usual standard and transmission-based precautions in operatory but with greater attention to detail and ensure that procedures are followed consistently and correctly.
Furthermore, we will employ an additional team member/ assistant whose main focus is only on sterilization. This team member will be responsible for cleaning, sterilizing, disinfecting and wiping down everything in the operatories and in the waiting room; chairs, handles, light switches, tables…etc. on a regular basis.
Virtual appointments, especially post-operative appointments will be employed wherever possible.
Hand Hygiene is performed by our team
· Before and after all patient contact, contact with potentially infectious material, and before putting on and after removing personal protective equipment (PPE), including gloves.
· After removing PPE in order to remove any pathogens that might have been transferred to bare hands during the removal process.
· Washing hands with soap and water for at least 20 seconds
Personal Protective Equipment
· Wear PPE (masks, gloves, cap, eye protection, face shields, gowns (N95 masks when around confirmed cases)
· Masks are one time use and replace if soiled
· N95 respirators are used when performing or present for an aerosol-generating procedure.
· Wear goggles or a disposable face shield that covers the front and sides of the face) upon entry to the patient room or care area.
· Reusable eye protection (e.g., goggles) must be cleaned and disinfected according to manufacturer’s reprocessing instructions prior to re-use.
· Disposable eye protection should be discarded after use.
· Put on clean, non-sterile gloves upon entry into the patient room or care area.
· Change gloves if they become torn or heavily contaminated.
· Remove and discard gloves when leaving the patient room or care area, and immediately perform hand hygiene.
· Put on a clean isolation gown upon entry into the patient room or area.
· Change the gown if it becomes soiled. Remove and discard the gown in a dedicated container for waste or linen before leaving the patient room or care area. Disposable gowns should be discarded, and cloth gowns should be laundered after each use.
· Gowns should be prioritized for all aerosol-generating procedures and during activities where splashes and sprays are anticipated.
· These will be worn over running shoes unless team is wearing plastic shoes that can be wiped down and disinfected
Patients in the Operatory
· Health care personnel (HCP) will strictly follow basic infection control practices between patients (e.g., hand hygiene, cleaning and disinfecting shared equipment).
· Limit transport and movement of the patient outside of the room
· Consider placing x-ray equipment in patient operatories to reduce the need for patient transport.
· No other team member should enter the room during a procedure and if necessary, should use PPE as described above.
· Room doors should be kept closed except when entering or leaving the room, and entry and exit should be minimized.
· Once the patient has left the operatory refrain from entering the op until sufficient time has elapsed to remove potentially infectious particles.
· After this time has elapsed, the room should undergo appropriate cleaning and surface disinfection before it is returned to routine use
· Special precautions will be taken when performing Aerosol Generating procedures (AGP), in particular, procedures that are likely to induce coughing are avoided if possible.
· Patients undergoing aerosol-generating procedures are in a separate op.
Protocols After the Clinical Treatment
· All non-disposable medical equipment used for patient care should be cleaned and disinfected according to manufacturer’s instructions.
· Ensure that environmental cleaning and disinfection procedures are followed consistently and correctly.
· Routine cleaning and disinfection procedures (e.g., using cleaners and water to pre-clean surfaces prior to applying an EPA-registered, hospital-grade disinfectant to frequently touched surfaces or objects for appropriate contact times as indicated on the product’s label) are appropriate for SARS-CoV-2 in healthcare settings, including those patient-care areas in which aerosol-generating procedures are performed.
· We are also in the process of purchasing a mobile, self-contained germicidal cleaning device that uses proven ultraviolet emitting radiation technology to help reduce and eliminate bacteria, viruses and other pathogens on environmental surfaces and is approved by the FDA.
Safety Measures After the Visit
· Encourage payment by credit card over the phone to encourage social distancing with front desk
· Review of estimates and insurance forms can be carried out via phone call or video conferencing and sent via mail
· Patients wash hands before leaving.
At the End of the Day
· A special cleaning crew has been hired to clean and disinfect the office from top to bottom in preparation for the following day.
Our team is confident that these guidelines will help to create a safe environment for both patients and team members and are intended to provide a sense of security. We will continue to monitor the CDC recommendations and swiftly implement any new recommendations.