Staying Open During the second Lockdown
Further to the announcement of another Lockdown in England from Thursday 5th November until December 2nd, we want to reassure our patients that rightly we have been deemed as essential healthcare and therefore will continue to provide our full range of care during this lockdown, including hygienist appointments.
Since reopening in June we have had the opportunity to implement certain changes to our operating protocol, as those of you who have already attended recently will know. We still need to remain very vigilant and proactive in ensuring the safety of ourselves and our patients and you can rest assured that should we be advised we need to take further steps we will do so. We look forward to welcoming you.
Thank you for your continued support.
High-Pressure Plasma Air purifiers and Fogging.
We are pleased to announce that we have invested in two state of the art ‘Air Purification’ systems that use high pressure electrostatic cleaning of the air and can clean and absorb particles and aerosols as small as 14.6nm. (Much smaller than SARS-CoV-2 (Covid 19)
An electric field of 20,000 to 40,000 volts effectively inactivates bacteria and viruses and has been shown in laboratory tests to kill up to 99.97% of bacteria and viruses, including Novel Coronavirus.
Most conventional air purifiers use HEPA filters that only adsorb particles. They do not ‘kill’ viruses and bacteria. The electrostatic plasma air purifiers can directly kill the virus using electric fields of tens of thousands of volts.
In independent laboratory tests it has been shown that the killing rate of H3N2 influenza virus within 1 hour is greater than 99.97%.
Whilst the Sars-CoV-2 virus is a new virus and we still have a lot to learn about it, we feel as a practice that this investment is something we can do to try and ensure the practice and in particular the surgeries remain as safe an environment as we can possibly achieve.
The large Q7 unit in Peter’s surgery purifies the air in the surgery over 20 times per hour (the entire volume of air in the room passes through the machine over 20 times in an hour) and the smaller Q3 unit in Fiona’s room will clean the air with over 13 entire air passes per hour.
Public Health England has said “A single air change is estimated to remove 63% of airborne contaminants, after 5 air changes less than 1% of air contaminant is thought to remain.”
The Q7 machine essentially results in 5 air changes every 15 minutes, and the Q3, 5 air changes every 23 minutes. Assuming PHE are correct the airborne contamination within the surgeries will remain exceptionally low all the time the machines are operational.
The units contain particle sensors and the units measure the AQI. (Air Quality Index) This is an indicator of air quality and runs from 0 to 500. A reading of 0-50 represents good air quality and poses little or no risk.
Although we have only been using these units for a short time, the AQI readings are generally less than 10, which represents minimal contamination and excellent air quality.
In addition to the air purifiers, following any dental treatment, we also use a ‘fogging machine’. Ultra-low volume fogging involves the generation of a cloud of extremely small droplets of disinfectant and can significantly reduce the number or pathogens on surfaces and in the air. These droplets can settle underneath, on top of and on the sides of many objects and surfaces which can be very difficult to reach using conventional methods of cleaning.
Rapid ULV fogging and disinfection enables the treatment of large areas in a short space of time and will help to quickly break the chain of infection. We use a disinfectant solution that is harmless to humans (in the concentrations used) but quickly deactivates and kills hazardous airborne viruses, fungi and bacteria.
Further to the fogging, the surgery is left empty for a period of time to allow the air to settle and then one of our team re-enters the room to undertake manual cleansing of all work surfaces and floor.
By employing both methods of air cleansing and disinfection we are confident we have reduced any risk of cross contamination to an absolute minimum.
Practice Update 28th June 2020
Its now been 10 days since we we able to re-open and we are slowly becoming used to a new way of working. We have dealt with those who contacted us with urgent problems and are now ready to see anyone who needs any attention, but didn't feel it was of enough urgency to come and see us straight away.
Whilst we are at level 3 of the Covid-19 alert status, the advice is that we still shouldn't see any routine cases or in any way get back to doing routine check ups or hygiene appointments. However, we do feel that those of you who were in the middle of any treatment need to contact us so that we can start to schedule the appointments. These are challenging times for us financially and we are keen to do as much as we can to secure our future as a practice.
We are also able to see people who used to see Fiona frequently because of significant gum problems. To start with Peter will undertake the treatment as we are still very short staffed due to one nurse being on maternity leave and another who is unable to work.
For anyone who is anxious about coming to see us, the following is from an email that we received from a patient who came to see us this week.
''I just wanted to say how incredibly hard yourself and your staff team worked to make me feel safe, from entering the practice to sitting in the dentist chair. To be in all that PPE must’ve been very restricting and frustrating but I felt like I received the same outstanding service from all involved.''
To recap, we are able to see people with the following problems;
• Obviously those in pain or discomfort
• Hygiene appointments if you attended frequently
• Loose or lost fillings crowns/bridges etc
• Broken teeth or sharp areas
• If you are half way through a course of treatment
• Gum problems or concerns about anything in your mouth
• Denture problems
• Concerns about implants
As ever, we will see you as soon as we can. If you would like an appointment please call us on 01235 521129 or email email@example.com. You can monitor our facebook pages @StHelensDental.
Post COVID-19 Reopening Policy
This policy has been created based on multiple updated sources from within the dental and medical professions and the government.
It outlines modifications to our normal procedures that we intend to employ once the practice can be reopened now we have been advised we can resume seeing patients face to face.
It is not known at this time whether these procedures are temporary or whether they will become a permanent feature of the way dental practices must be run in order to ensure patient and staff safety in the future.
The worldwide COVID-19 pandemic is still being evaluated and studied and policies and recommendations are likely to change in line with new scientific evidence over time.
We would like to thank all of our patients for their patience and forbearance during the period of temporary practice closure and for their understanding and cooperation whilst we implement new measures at the practice.
We will of course be providing dental care to all of our patients in the safest possible environment, and we greatly appreciate your assistance with any new or modified procedures at the practice
It has always been our intention for the practice to re-open to patients as soon as we were allowed, to with the proviso that we can ensure as far as we are able, the safety of staff and patients. The government announcement last week came entirely out of the blue and the profession had no prior notice that the date of Monday 8th June had been set. Unfortunately, in spite of what you may hear from government sources, there is still an acute shortage of medical grade PPE, outside of the main hospital settings, and we are having extreme difficulty in resourcing ‘certified’ supplies. As a result we may be very limited as to what we can do from this date. Our team has been working hard behind the scenes to prepare the practice for reopening and have updated our policies and protocols to ensure your safety is paramount.
Initially we will prioritise the following patient groups:
Patients with emergency problems or other dental problems that require urgent assessment and treatment.
Patients with treatment that was incomplete before the practice was temporarily closed and which if left mat compromise the outcome of the treatment already started.
Further to the above patient groups we intend to prioritise patients who were due for routine examinations and hygienist visits during the period of closure, although this will largely depend upon the UK COVID-19 alert level. At the time of writing is still at level 4. This is the second highest alert level and this must be borne in mind when a decision is made to see patients for routine care.
In addition to this any patients in any of the above groups who are deemed to be at a higher risk from Covid-19 will have to be scheduled at the start of the day.
Patient communication before reopening
Our receptionist will be contacting patients to confirm appointments ahead of their scheduled time.
We will request that all patients who are attending Saint Helens Dental Practice update their standard medical history forms beforehand. We can send these to you, preferably by email and would ask that these are completed before you attend the practice.
We will also ask you to complete a risk assessment form that will allow us to assess your level of risk for coronavirus infection before you attend the surgery.
New Measures to reduce the risk of COVID-19 Transmission
Our normal cross-infection control protocols at Saint Helens Dental Practice against all previously known pathogens were already woven into all clinical activity carried out at the practice, and it should be mentioned that a dental practice is already a very clean environment compared to almost all other public areas. It is also worthwhile noting that there is no evidence of COVID-19 transmission occurring in increased rates amongst dentists or their staff.
We have collectively evaluated all of the updated guidance and observed what measures have been put in place in other countries. We feel that the measures that are outlined in this policy will reduce risk to the minimum level at the practice.
Please be assured that all of our clinical staff will be complying with our updated procedures to reduce the risk of cross infection in both directions.
Before Attending the Practice
Prior to your appointment we will send you a new medical history form and a Covid-19 risk assessment document. Wherever possible we would ask that this is returned to us before your appointment. In time, we will try and produce some online forms which you can easily complete and return via email.
If you have any difficulties with completing the forms we can our team are here to assist.
If it is felt necessary or it might help in determining what treatment we may need to undertake, Peter (Dr. Sands) may request a video consultation. This could help in formulating a provisional treatment plan which in turn could minimise the number of visits you require.
If for any reason it is felt that there is a risk you may have any symptoms of Coronavirus, or that you have recently been in touch with anyone who may have symptoms of Coronavirus, even if you asymptomatic, we will respectfully request you delay booking any appointments with us for at least 14 days. If you are in pain and you feel you fall into the above category, we will do everything we can to help you until such time as you can receive treatment safely. This may mean referral to a specialist Urgent Dental Centre.
We recommend that patients in the high-risk groups for developing complications from coronavirus delay non-essential dental treatment for as long as possible until the trend of the pandemic becomes clear. If you are in a high risk group and do require treatment we will schedule your appointment at the beginning of the day.
To find out whether you are in a high or very high-risk group please visit the following website https://www.nhs.uk/conditions/coronavirus-covid-19/people-at- higher-risk-from-coronavirus/ or ask any member of our team for guidance.
Travelling to the practice for your appointment.
When travelling to the practice, we would recommend that you limit close contact with other members of the public as far as possible.
Please endeavor to arrive no more than five minutes before your scheduled appointment. If you are travelling by car and can be dropped off we would be grateful if you could wait in your car and call the practice on 01235 521129 to confirm your arrival. If this isn’t possible, then on arrival please let us know you are here by using the door entry intercom.
We ask that if the appointment is for a child, they are accompanied by one adult from the same household. Please do not bring additional family members with you unless they are happy to wait in the car or outside the building.
Arriving at the Practice
When attending the practice please bring as few personal possessions as possible. Any possessions you do have will be placed in a clean box which will then be sealed and placed outside the surgery. Whilst we are able to control who may enter the building, we cannot accept responsibility for your personal items.
As much as it possible to do so, please plan your visit so you are least likely to need to use the practice toilet facilities during your visit. If you do need to use the toilet please follow all normal etiquette, which includes closing the toilet seat before flushing and ensure you wash your hands thoroughly as directed by the poster above the hand basin. The toilet will be disinfected between use.
We intend to minimise waiting inside the practice and at reception. Accordingly, appointments will be staggered so that patients do not arrive or leave at the same time as other patients as far as we are able to manage.
On arrival you will be met by one of our team and we may take your temperature with a no-touch thermometer. However the evidence for this is that it is an unreliable screening tool. You will be asked to use hand sanitizer immediately on entry to the building and we will give you a face mask which you will wear whilst in the building other than when you are receiving treatment.
Assuming we can see you, we will direct you straight to the surgery. Once in the surgery we will mask you to use the hand sanitizer once more. You will remove your face mask and place it in the plastic bag you will be provided with. We may ask you to rinse your mouth with and antibacterial and antiviral mouthwash, although there are also doubts as to whether this is necessary.
We have spent time critically looking at every aspect of the practice with a view to removing all non-essential items that can potentially be the cause of infection.
You will find that the practice does appear quite bare compared to before as all ‘wall decorations’ which cannot be easily wiped clean will have been removed.
All clinical and common areas including door handles and surfaces will be regularly disinfected in addition to our normal surface cleaning protocols between patients.
We will be providing a buffer period between patients to allow additional time for additional decontamination procedures, allow for any treatment overruns and allow preparation time for the next patient so that they do not need to wait in the reception area. After some treatments, the guidance is that the surgery cannot be used for an hour.
All future appointments will be made and confirmed by email or telephone to limit your time spent at reception.
Saint Helens Dental Practice will be introducing contactless payment systems going forwards, but is may be necessary to use the normal card machine for payments. This will be decontaminated as much as possible between each use and you will be offered some hand sanitiser after you have used the machine.
You will then be escorted to the front door where you can remove and discard your face mask before leaving.
All dental staff will be using personal protective equipment in line with current recommendations and evidence.
We apologise in advance for the necessary reduction in social interaction that this will necessitate. Whilst our PPE may make us appear impersonal and distant, please be assured we are still the same friendly people underneath it all!
We are especially mindful that many dental treatments are aerosol-generating procedures (AGP’s). It is difficult for us to carry out some dental procedures without generation of some level of aerosol. Aerosol suspended in the air is a theoretical source of infection which we obviously wish to keep to a minimum. Currently the dental literature suggests:
Our use of our normal high-volume suction reduces aerosol production by over 90%.
The use of dental rubber dam where appropriate reduces bio- aerosols by a further 30 to 90%
Our regular facemasks filter approximately 60% of remaining airborne particles.
The FFP2 and FFP3 masks we will be using during all aerosol generating procedures, filter 94% and 99% respectively of airborne particles in both directions (patient to clinician and clinician to patient).
Existing patients who have received any treatment will know that we routinely use what is called a rubber dam when we do fillings and the placement of this ‘dam’ very significantly reduces the amount of Bio aerosol produced. This and the use of the high volume suction system, the pre-treatment screening and triaging will enable us to undertake most of our routine dental procedures with minimal additional risk to our patients and our own team.
The incidence of Covid-19 in this region remains to be relatively low and the vast majority of our patients remain free of Covid-19 related ill health. We are confident that we will be able to provide normal dental care for our patients in as normal an environment as possible while bearing in mind our responsibilities to mitigate risks of infection spread as far as is practically possible.
Our policies and procedures will be constantly reviewed and updated as necessitated by circumstances and the best available evidence over time.
If you have any questions regarding this policy or about your dental care at Saint Helens Dental Practice please do not hesitate to contact us on 01235 521129, firstname.lastname@example.org or Fiona@abingdondentalcare.co.uk who will be pleased to try and answer any questions you may have.