Be Ready to Reopen, Part One

Here’s What You Should Be Doing Now to Reopen with a Seamless Transition

Dental practices around the world continue to be impacted by the unprecedented disruption caused by the COVID-19 Pandemic. Although uncertainty remains about when this crisis will abate, the American Dental Association (ADA) recently provided a new interim recommendation that “dentists keep their offices closed to all but urgent and emergency procedures until April 30 at the earliest.” While no one can say for certain whether that April 30 date will hold, it is important to be prepared now, so you know what steps to take when your practice fully reopens for all procedures.

Although this is a unique situation, it is not unheard of for practices to close for more than a week at a time, perhaps over a holiday. All practices should have a standard operating procedure (SOP) in place that details steps for closing an office, maintaining it while closed, and opening it back up. If your practice does not have one, now is the time to develop it. It is important to have those procedures in place to ensure a seamless transition back to fully functioning practice.

From administrative to clinical to infection prevention tasks, there’s a lot you can and should be doing to keep your practice in good shape. Part one of this post will examine best practice recommendations for temporarily closing an office as well as what can be done during this interim downtime. Part two will then detail steps for reopening the practice for all procedures.

LIMITING TREATMENT OR CLOSING A PRACTICE

There are some best practice recommendations that a practice should take prior to limiting patient treatment, or temporarily closing the office. It is not too late to take action if any of these steps were missed. It is also important to remember that an established standard operating procedure would include these recommendations.

Administrative Tasks

Before closing a practice, there are a number of administrative tasks that need to be accomplished. For any standard closure, that includes determining a specific date and time for closure and notifying patients. Any patient communication should include contact information for emergencies as well as explaining what constitutes an emergency. In these special circumstances surrounding COVID-19, the ADA has developed guidance for defining a dental emergency. This flowchart is a useful tool for triaging patients.

A practice can also stay connected to patients by developing social media channels for ongoing communication and practice updates. Showing how the team is staying busy with training, cleaning, and organizing is a great way to illustrate your investment in the office.

Before closing, it is also important to back up all patient data and make arrangements for accepting packages and other deliveries if the staff won’t be at the office.

Clinical and Infection Prevention Tasks

From a clinical and infection prevention perspective, these steps need to be taken prior to limiting treatment or closing your practice. First and foremost, disinfect all environment surfaces and equipment with an EPA registered intermediate-level disinfectant approved for use against SARS-CoV-2, such as AdvantaClear™ Surface Disinfectant. That includes treatment rooms, clinical support areas, reception, restrooms, and any other area within the practice.

It is also important to clean, dry, package, sterilize, and store all instruments to ensure they will be ready for use upon your return. Before closing is also a great time to send your instruments out for sharpening if needed. If you use an ultrasonic unit, it should be empty and cleaned. Also, be sure to process a biological indicator or SporeCheck for your sterilizer and record the results.

For dental unit care, empty and clean your water bottles or reservoirs (per manufacturer instructions) and purge water from all lines.  Clean and replace amalgam traps and remove all handpieces before lubricating and sterilizing. If you have a dental unit waterline treatment products such as Dentapure Cartridge^TM or a Hu-Friedy Waterline filter, check the instructions for use (IFU) or contact the manufacturer for proper procedure.

While it may seem like an obvious point, be sure to turn off all power to equipment. Finally, check your inventory to make sure you have the clinical and infection prevention products to conduct emergency procedures and maintain infection control. This Infection Prevention Product Resource Guide has a great run-down of the products needed to maintain a safe environment.

MAINTAINING YOUR PRACTICE DURING LIMITED TREATMENT TIME OR TEMPORARY CLOSURE

Once you’ve prepared your practice with the proper steps to wind-down treatment or temporarily close, it’s important to keep up that good work with ongoing maintenance. Use this time to review protocol and complete tasks and projects that are difficult to do when the practice has a full schedule of patients.

Infection Prevention and Control

Since it will be top of mind for most people, start with a review of your infection prevention policies. If your practice doesn't have an infection prevention and control coordinator, now is a great time to appoint one so they can use this time to complete additional training and prepare any protocol updates. The Essential Guide to Infection Control eBook is a good place to get started, and the CDC Infection Prevention Checklist for Dental Settings can help in developing and maintain written infection prevention policies. Additionally, the GreenLight Dental Compliance Center™ by Hu-Friedy continues to be an invaluable resource for compliance, with convenient and cost-effective access to comprehensive regulations to help comply with better infection prevention.

An infection control coordinator can help set protocol for screening patients with respiratory symptoms and/or exposure to respiratory infections as well as adding and updating infection prevention information on the practice website and social media accounts.

It is also a good time to update OSHA and HIPAA training for the whole team in addition to doing a thorough review and update of PPE policy. It will be critical to returning to normal practice with a robust and clearly communicated approach to infection prevention.

Maintenance and Upkeep

Just because practices are temporarily closed or seeing a limited number of patients doesn’t mean there still isn’t daily or semi-daily maintenance required. Here are some suggestions on what you can be doing, but it is important to remember to read and understand the IFUs for all your equipment, as that will be your best indicator on what maintenance is needed.

Sterilizers should be monitored at least weekly using a biological indicator. This should still be done even during times of limited treatment. Clean and close the unit following the manufacturer’s IFU and drain the water reservoir.

In general, unplug or switch the power off for any equipment that won’t be used. For any air compressors, power them down, release all air, and drain tanks where applicable. Replace amalgam separator canisters to prevent any leakage. 

If you use a water purification system, be sure to turn off  the water supply and empty any connected storage tanks. If you have a centralized water filtration system connected to dental operatories, yo should use air to purge water from all connected water-bearing lines. Please refer to the procedures for both the VistaClear™ Centralized Water Filtration System and VistaPure™ Water Purification System.

If a waterline treatment product is used, such as DentaPure Cartridge^TM or a Hu-Friedy waterline filter, and you are maintaining the operatory for emergency use, perform a two minute flush of all lines, including unused lines, that draw water from either DUWL bottle or a municipal source at the start of each day. Throughout the day perform 20-30 second flushes of all devices connected to the dental water between patients. And at the end of the day, if using a bottle system, empty the bottle and return to the manifold.

By understanding IFUs and taking the time to properly maintain your equipment, you will avoid any issues that might cause a delay in opening up your practice. Patients are going to be ready to go to make up for missed appointments, and the last thing your practice needs is lost time due to an unforeseen mishap with your equipment.

AND THEN, SHIFT YOUR MINDSET

Although all of the above is quite the undertaking, the most important non-clinical change will be your mindset. And right now is the perfect time to think through where your practice has been, where it is going, and what your patients are going to need to see and hear in order to feel comfortable coming back to your practice. What has to be done before you can safely reopen your practice? What will be done differently? What has to be communicated and how in order to instill confidence in patients and staff? When your practice reopens, it will be in a post-COVID-19 world, where the old normal will simply not exist. Your practice needs to be safer than ever before when it comes to infection prevention. But nothing happens without a decision to make it happen.