| We appreciate that many of you are slowly ramping
up non-urgent care in accordance with the Governor’s guidance and we
understand that some have been constrained by PPE availability.
Advantage Dental’s Director of Practice Support has been engaged
almost full time researching sources for PPE and he located a source
we’re able to share. This source has been vetted and determined to be
reliable but, as with other sources, there is much competition for
limited supplies during this time of shortage and practices are
advised to do their own research for compliance. If you are having
difficulty securing PPE, you can try contacting Shane Erickson:
Shane@imcsuccess.com
IMC Success
Cell -612.865.4624
The Oregon Dental Association has also published a
list of possible PPE source on their website at:
https://www.oregondental.org/government-affairs/regulatory-information/coronavirus/ppe-resources
We have successfully opened most of our staff
model offices for elective care, but we are also constrained by
availability of PPE. To conserve PPE, we are following CDC
guidance for extended use and limited reuse of N95 masks. Below is a
summary of the guidance from CDC for your information:
RECOMMENDED
GUIDANCE FOR EXTENDED USE AND LIMITED REUSE OF N95 RESPIRATORS IN
HEALTHCARE SETTINGS
The
decision to extend use or reuse N95 respirators should be made by the
professionals who manage the respiratory protection program. All
recommendations and plans will follow current OSHA and CDC guidance
and statements as well as input from the state/local public health
departments.
The
decision to implement these best practices should be made on a
case-by-case basis taking into account the following:
• Respiratory
pathogen characteristics (e.g., routes of transmission, prevalence of
disease in the region, infection attack rate, and severity of
illness);
• Local
conditions (e.g.., number of disposable N95 respirators available,
current respirator usage rate, success of other respirator
conservation strategies, etc.).
Healthcare
facilities may wish to implement protocols for extended use and/or
limited reuse of N95 respirator when supply shortages become
critical.
The
following sections outline specific steps to guide implementation of
these recommendations, minimize the challenges caused by extended use
and reuse, and to limit risks that could result from these practices.
Respirator
Re-use Recommendations
**
Current guideline for care group emergency practices**
To
help limit potential N95 respirator surface contamination:
·
Use of barriers to prevent
droplet spray contamination
·
Cover N95 respirator with
disposable level 3 mask
Reminders
for team members:
·
N95 respirators must only be
used by a single wearer
·
Follow the manufacturer’s user
instructions, including conducting a user seal check
·
Minimize unnecessary contact
with the respirator surface
·
Maintain strict adherence to
hand hygiene practices
·
Properly don and doff PPE and
when appropriate, store N95 for reuse (review the N95 re-use and our
Sterilization videos)
https://twitter.com/i/status/1245678763574206464
https://vimeo.com/349141076/fa57980d07
Please
take the following steps to reduce contact transmission:
Discard
N95 Respirators:
·
Following use during aerosol
generating procedures
·
If contaminated with blood,
respiratory or nasal secretions, or other bodily fluids from patients
·
Provider should use best clinical
judgment if question arises as to whether to discard or not discard
·
Discard if there are any
defects noted (e.g., broken or worn straps, bent or torn mask)
N95
Re-use:
Extended
use and reuse can affect the integrity of the mask. A self-seal check
and inspection must be performed each use to ensure a proper seal is
in place and there are no defects in the mask.
·
If available, use a cleanable
face shield (preferred) and cover N95 mask with a level 3 mask and/or
take other steps (e.g., masking patients, use of engineering
controls), when feasible to reduce surface contamination of the
respirator
·
To minimize potential
cross-contamination, store mask in container by itself. Clean or
replace storage containers regularly (Please see video link above)
·
Storage containers should be
disposed of or cleaned regularly using:
o Cavicide
wipes (*preferred)
o Using
warm water and soap
·
Clean hands with soap and
water or an alcohol-based hand sanitizer before and after touching or
adjusting the respirator
·
Avoid touching the inside of
the respirator
·
Use a pair of clean
(non-sterile) gloves when donning a used N95 respirator and
performing a user seal check
·
Discard gloves after the N95
respirator is donned to ensure the respirator is sitting comfortably
on your face with a good seal
https://www.youtube.com/watch?v=3I_kKVNrEMo
At our staff model practices as we begin
scheduling patient appointments previously cancelled, we continue to
offer a telehealth option to triage and prioritize care. Attached is
the ADA Guideline for Coding and Billing to be used as a reference if
you are using teledentistry in your practice during the COVID-19
crisis.
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