Trust is integral

Trust is integral in our relationships with patients and is going to be vital when we eventually reopen our doors.

How are you using this time to deepen the trust your patients have in you?

Information and demonstration of how you keep your patients safe through rigorous cross infection is vital

Slow dentistry recommends the following 10 steps https://www.slowdentistry.com/news/10-steps-to-fight-cross-contamination

1. Regularly clean floors and surfaces of nonclinical areas with a good detergent and if possible, have an allocated person to do this at regular intervals. All floors and surfaces (even non-technical), door handles and bathrooms should also be cleaned with an antiviral, antifungal and bactericidal and always remember to wash top down. Meaning high surfaces first, before the floor.

2. All staff must wash hands regularly for at least 20 secs. This should be done after toilet breaks, coffee breaks and at set intervals. Posters should be placed near each hand basin advising best hand washing practice and training with regular reinforcement detailing this should happen.

3. There should be a clean zone in every clinic where only dental/medical staff with properly disinfected clothes and shoes can access. All non-dental/medical people should wear special shoe protection in these areas. These include patients, caretakers, children, delivery and technical personnel. Clothes, including shoes, used in the clinic should not be allowed to go outside and should be washed with high temperatures regularly. Hand sanitizers with the appropriate liquid should be made available at the entrance to the practice, and also of each one operatory room, at the reception, at the bathrooms and staff quarters.

4. All delivery packages (UPS/DHL, laboratory work, etc) should be disinfected and wiped down prior to entering the clean zone. Both the outer box that was being transported and later the inner packaging too. This is particularly important for laboratory work; it is the responsibility of the dentists to disinfect all work going out to dental laboratories.

5. Each treatment room should be appropriately disinfected after being tidied in between appointments. A minimum of 10 minutes turn-around time should be respected to allow for the bactericide/fungicide/virucide effect of cleaning materials. A clinic can see as many patients a day as it sees fit but will always guarantee that this disinfection time interval is respected, even if an appointment is only 5 minutes long. (When in a pandemic state, like Covid-19 brought us, this rule should be complemented with more guidelines provided by WHO and similar)

6. Reception should avoid shaking hands with arriving patients and they should respectfully be requested to wash hands immediately upon entering the practice as well using the available hand sanitizer after. Also opt for a welcome greeting instead of a handshake. In some countries a customary kiss is given. This should be avoided, and staff should respect this too. Management commit to sending all staff members with any flu symptoms home and regularly measures staff temperatures.

7. Clinical staff should wear appropriate safety equipment such as gowns, hair coverings, goggles/visors and masks for all treatment -FFP2/FFP3 masks are best practice. This safety protection equipment should also be made available to all patients prior to entering treatment area and disposed of, safely, after use.

8. Antimicrobial mouthwash as well as hydrogen peroxide (H2O2 - for 1 minute) should be used by the patient prior to treatment.

9. It is very important that procedures that create aerosols, that high speed aspiration will always be ensured by a dental assistant, and not done alone, to help reduce aerosol production during specific aerosol generating procedures such as cleanings, restorative dentistry, endodontics and others, alongside the use of a rubber dam.

10. All rooms will be aired regularly, and disinfectant ambient aerosols used in between patients to allow for the air to be purified/disinfection. If possible, air filtration using appropriate HEPA filters, should be installed. We also recommend any systems that can help improve air sanitizations. Likewise, it is important to make sure work returning has been treated accordingly to protect the staff at the laboratory. We highly recommend investing in regular cleaning of air filters, air conditioner systems as well as the use of air sanitization technologies, such as ozone, uv, etc.

I am curious

• What changes to cross infection control do you expect to enhance when you return?

• How are you using the time, now, to communicate to your patients what you already have been doing routinely and what you will implement in the future?

As a note I do think the use of the word regularly, as used by slow dentistry does need to be defined.