INTERIM GUIDANCE FOR DENTAL PRACTICES DURING COVID 19 GLOBAL EMERGENCY IN NEPAL 2020

  • INTERIM GUIDANCE FOR DENTAL PRACTICES DURING COVID 19 GLOBAL EMERGENCY IN NEPAL 2020

    Table of Content
    1. Introduction 4
    2. Objectives 5
    3. Before Dental Treatment 6
    i. Safety and Training of Dental Health Care Providers 6
    ii. Pre-appointment Screening 6
    iii. Reception Area Set Up 7
    iv. Patient Arrival-Screening and Triaging 8
    v. Categorization of Dental Need 10
    4. Personal Protective Equipment Checklist 11
    5. Preparation of Operatory 11
    6. Hand Hygiene Protocol 12
    7. Donning of PPE 14
    8. During Dental Treatment 16
    9. Between the patients 18
    10. After Dental Treatment 18
    11. Decontamination of Patient treatment Area 18
    12. Before leaving Operatory 19
    13. Doffing of the PPE 20
    14. Accidental exposure and follow up 21
    15. Summary of guideline 22
    16. Sterilization of equipment 23
    17. Waste management 23
    18. Further references and Protocols 23
    19. References 25
    20. Annexures 28
    21. Contributors 35
    1. INTRODUCTION
    On January 30, 2020, the World Health Organization (WHO) announced that COVID-19
    outbreak had constituted a public health emergency of international concern. The novel
    coronavirus was initially named 2019-nCoV and officially as severe acute respiratory
    syndrome coronavirus 2 (SARS- CoV-2). Since the declaration of public health emergency by
    the WHO, Government of Nepal too has undertaken necessary actions to prevent the spread
    of Covid19 in the country and enforced lockdown in the country from 24 March 2020 onwards.
    Dental staff and dental practitioners (Dental health care providers) are considered to be at
    highest risk of acquiring the infection because of prolonged face to face exposure to patients,
    exposure to respiratory secretions and aerosols produced during procedures like ultrasonic
    scaling and cavity/access preparation using a high speed air rotor with water jet cooling
    systems. Dental procedures causing splatters, fomites and aerosols can propel a high viral
    load in the procedure room there by increasing the risk of cross infection between dental
    practitioners, patients, in-between consecutive patients as well as dental auxiliary staffs.
    Recent observations have proven that salivary glands act as the reservoirvirus for Active and
    live virus have been isolated from saliva of patients who were asymptomatic or were
    considered free of the disease suggesting that COVID-19 transmitted by asymptomatic
    infection may originate from infected saliva.
    Many countries and dental communities have advised to stop general dental procedures and
    only provide essential emergency dental care. There are no clear consensus on continuation,
    resumption and extent of dental practice in coming days following this pandemic tdown.Shu
    of dental treatment will definitely reduce the risk of transmission cluster from dental offices but
    in long term, this willlead to accumulation of cases and conversion of a easily treatable case
    into an emergency or non-salvageable case. This case burden will definitely strain the dental
    community in near future therefore resumption of dental treatments with very clear case
    prioritization, infection control, transmission reduction and safety protocols are the
    need of the day. As the graph of COVID-19 infection lowers down and flattens DHCPs
    shouldbe ready to resume our services with universal standards of care based on multiple
    evidence and international guidelines tailored to suit our national resource availability and
    community characteristics.
    This interim guidance is based on evidences, guidelines and researches and is being
    published to introduce the essential knowledge to protect and prevent OVIDC-19 in dental set
    up and nosocomial infection in dental settings. It is an attempt to provide recommended
    management protocols for dental practitioners and specialists working at different levels of
    dental care providing set ups (dental colleges, postgraduate institutes, dental hospitals, dental
    departments at government hospitals, private clinics) with strict and effective infection
    control mechanism in place. This interim guidance is dynamic document and subject to editing,
    changes and further recommendations as and when new validated evidences, researches
    evolves.
    2. OBJECTIVES OF THE GUIDELINES
    This interim guidance provides a guideline for dental patients’ management during and
    after the COVID-19 pandemic. These will safeguard dental health care providers from
    acquiring COVID-19 infections and prevent cross transmission among patients.
    • Screening every asymptomatic patient meticulously.
    • Considering every patient as potential asymptomatic COVID-19 carrier.
    • Isolation and transfer of suspected patients to the local health authority for testing and
    keeping contact of every patient for contact tracing if required
    • Considering recently recovered patients as potential virus carriers for at least 30 days
    after the recovery confirmation by a laboratory test
    • Identifying the urgent need of the patient and focusing on managing it with minimally
    invasive procedures.
    • Categorising dental treatment according to the urgency of the required treatment and
    the risk and benefit associated with each treatment.
    • Identifying the required dental treatment for each patient and the risks and benefits
    associated with that treatment.
    • Categorization of personal protective equipment(PPE) for different procedure.
    • Preparing clinics / hospitals / institutions with COVID-19 safety standards
    • Preparation and training of reception staff, dental hygienists,chair side assistants
    and cleaners for maintaining safe practice
    • Preparing checklist based PPE donning and doffing protocol based on level of exposure
    and procedure
    • Preparation of operatory and maintenance of high standards of disinfection in operatory
    • Protocol for instrument sterilization and waste management from Dental settings
    • Accidental exposure management recommendations
    • Optimization of resources like PPE, Facemasks, respirators and Eyewear during
    scarcity
    The overall aim of this interim guidance is to allow dental practice to be resumed at all levels
    with highest standards of safety to the patients, to ensure safety of staff and dental
    professionals involved in the treatment and prevent transmission of COVID-19.
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