Getting Back to Work

If you’ve been watching the news, you may have seen news reports discussing how dental professionals—specifically dental hygienists—are at the highest risk of exposure to the novel coronavirus due to how close we must come to our patients and the inherent risks of microorganisms contained within aerosols. As shelter-in-place orders across the nation begin to expire, we need to consider what returning to work will look like, and what steps should be taken to protect ourselves.

First, we must ensure that plans are in place and proper tools are available. According to the Occupational Safety and Health Administration (OSHA), this means appropriate engineering and administrative controls, as well as personal protective equipment (PPE).

Engineering controls do not rely on worker behavior and include items such as high-efficiency air filters and negative pressure ventilation in settings that produce aerosols.² Neither of these is common among traditional dental practices. The United States Centers for Disease Control and Prevention is also recommending that you avoid aerosol-producing procedures whenever possible.³

Administrative controls require actions by employees such as establishing alternating workdays to reduce the number of employees in a facility at any given time and providing workers with training on COVID-19 risk factors and important protective behaviors.² This may also include altering how patients are seen in the office. Keeping social distancing in mind, waiting rooms should not be packed with patients but rather patients should come in only when they are ready to be seen by the dentist or dental hygienist. If rooms do not have walls between them, or there is open space between operatories, it may also be beneficial to have patients placed in every other operatory to allow for continued social distancing.

Lastly, as per OSHA, employers are obligated to provide workers with the necessary PPE to do their jobs safely.² This varies depending on risk level, but oral health professionals are considered “very high exposure risk,” which is also in accordance with OSHA’s report. At a minimum, the use of level 3 surgical masks with a face shield should be worn when treating patients.³ However, for any procedure that generates aerosols, an N95 respirator or better must be used and should include fit-testing.² Level 3 surgical masks, when worn properly, can filter out approximately 80% of aerosols, while N95 masks can filter out 95% of aerosols.⁴ When talking about an infectious virus, this is a significant difference, which is why OSHA and the CDC have made such recommendations.

Of course, we are all aware of the current shortage in PPE, so some offices may be delayed in opening again. The CDC states that if a minimally acceptable number of surgical masks and a full-face shields is not available, the patient should be referred to a provider who has the appropriate protective equipment.³ Please continue to monitor updated guidelines and recommendations dissemination by OSHA and CDC.

References

1. Gamio L. The workers who face the greatest coronavirus risk. The New York Times. Available at: https://www.nytimes.com/interactive/2020/03/15/business/economy/coronavirus-worker-risk.html
2. Occupational Safety and Health Administration. Guidance on Preparing Workplaces for COVID-19. Available at: https://www.osha.gov/Publications/OSHA3990.pdf
3. United States Centers for Disease Control and Prevention. Coronavirus Disease 2019 Dental Settings Interim infection Prevention and Control Guidance for Dental Settings During the COVID-19 Response. Available at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/dental-settings.html
4. Coulthard P. Dentistry and Coronavirus (COVID-19)—Moral Decision-Making. Br Dent J. 2020;228:503-505. Available at: https://www.nature.com/articles/s41415-020-1482-1