We are starting our first day after the national emergency was declared by President Trump. We have two concerns.
Universal precautions should be enforced for item #2.
Regarding item #1, the concern is aerosolized droplets. This occurs readily in the dental office through the use of Prophyjets, Cavitrons, piezo operating instruments, and high speed handpieces.
This is a vacation week for us. Only hygienists are working. And we are making changes in hygiene delivery. I wrote the following to my hygienists:
We will use the forehead thermometers for each patient coming in. Based on our preliminary findings with the thermometers that we have, the cut off point would be 98.5 degrees. I’ll revise that as we see patients on Monday.
It is the aerosols that makes our staff most vulnerable. Therefore, I am discontinuing the use of the Prophyjet for all patients. We will use rubber cup only. Cavitron should be used only where absolutely necessary. As we are seeing PM’s this week, we should not have to use the Cavitron.
Hygienists need to be completely covered. Shoes either stay at the office or have shoe covers or both. I don’t know if we have shoe covers. Therefore, hygienists should bring shoes to the office that will remain there. All outerwear should be disposable or washable gowns and will be washed at the office.
We are using clear face shields over our magnifiers. As these are not easily adaptable to our headlights, we may have to use overhead lights if the headlights won’t work. We’ll have to work through that, and we will.
I will be at the office at 6 AM on Monday to orient you with the face shields and the thermometers.
I am using the following reference for guidelines. https://www.nature.com/articles/s41368-020-0075-9#Fig1
I was able find face shields today at Hope Depot and and local store. Here is the face shield that we are using: https://www.homedepot.com/b/Safety-Equipment-Head-Protection-Face-Shields/Bullard/N-5yc1vZclhuZgc4
I found forehead fever thermometers at CVS. They cost about $45 each
We have developed the following screening questionnaire for patients prior to beginning treatment:
(1) Do you have fever or experienced fever within the past 14 days?
(2) Have you experienced a recent onset of respiratory problems, such as a cough or difficulty in breathing within the past 14 days?
(3) Have you, within the past 14 days, traveled to areas affected by the virus, or visited the neighborhood with documented 2019-nCoV transmission?
(4) Have you come into contact with a patient with confirmed 2019-nCoV infection within the past 14 days?
(5) Have you come into contact with people from a neighborhood with recent documented fever or respiratory problems within the past 14 days?
(6) Are there at least two people with documented experience of fever or respiratory problems within the last 14 days having close contact with you?
(7) Have you recently participated in any gathering, meetings, or had close contact with many unacquainted people?
The forehead fever thermometer appears, by comparing with a mercury thermometer to run 1 degree cooler than the mercury thermometer. We will be doing more onsite testing to determine how universal this is. Keep in mind that in cold weather, the forehead needs to warm up for about twenty minutes in the building to make it as accurate as possible.