Safety Measures in Our Practice

Oral and Maxillofacial Surgery in Lakewood

Training and educating our team:

One of the most important things we are doing during this time is to train and educate our staff,

• Our team has had refresher training in proper hand washing techniques. This may seem basic; however, it is the most important thing we can do to prevent spread of the virus, yet research shows that it is often poorly complied with and usually not done well. Consequently, we have spent a lot of time ensuring that our team does it well and often, especially before and after every patient encounter.

• They have practiced the appropriate use of personal protective equipment (PPE) prior to caring for a patient to prevent contamination.

• We have everyone in the office take their temperature at the beginning of every day and we will immediately send home anyone with an elevated temperature (100.2 F and above).

• Limit the numbers of staff providing their care to facilitate social distancing within the office and among team members.

• We have created a specific checklist of recommendations for our team to follow so that they arrive to work healthy and go home to their families without worry. (see Checklist of recommendations for Our Team)

Recommendations for Our Team

Before Coming to Work

• Take temperature (do not go into work if you or any other family member are experiencing symptoms; cough, sore throat, fever…. etc.)
• Remove watch and rings and leave at home
• Tie hair up, keep nails short.
• Avoid extra accessories
• Place phone in a Ziploc bag that you will discard at the end of the day
• If bringing a lunch, place in disposable wrapping
• Bring work clothes in a washable bag (i.e. pillowcase)
• They have practiced the appropriate use of personal protective equipment (PPE) prior to caring for a patient to prevent contamination.

At Work

• Change into scrubs and work shoes (preferably plastic and wipeable) as soon as you arrive
• Use PPE as appropriate
• Leave all clutter (pens, phones, etc.) outside of patient op rooms
• We discourage staff from using other workers phones, desks, office and other work tools and equipment when possible
• Clean phone handsets after use
• Discourage cell phone use at work

After Work

• Wash hands and arms with soap
• Remove scrubs and place in washable bag or leave at work
• Wash hands and put clean clothes on
• Sanitize phones, glasses, etc.
• Wash hands again

At Home

• Do not touch anything
• Remove shoes and clothes
• Wash clothes/scrubs in the washing machine with detergent and hot water
• Shower immediately with soap and water before touching anything (including loved ones)
  

Patient Interviews and Social Distancing

Before patient arrival every effort is made to

• Filter patients during the phone call when scheduling appointments for care using established and recommended screening checklist and scripts
• Utilize scripts and questions to recognize potential carriers
• Reschedule patients who show any signs of a cough or who describe having any concerns warning signs
• Instruct patients to call ahead and reschedule their appointment if they develop symptoms of a respiratory infection (e.g., cough, sore throat or fever) on the day they are scheduled to be seen

To Promote social distancing

• Prioritize at risk patients (immune compromised, over 65 y.o. etc.) with early morning appointments so less contact with other people
• When booking patients, we are spreading out the schedule so there are less people in the waiting room and promote social distancing
• Utilizing an extended waiting room: patients may be asked to wait in their car or outside the office where they can be contacted by mobile phone when it is their turn to be treated

Safety measures taken upon arrival

• Leave office door open to avoid contact with door handles
• Masks and tissues are made accessible immediately upon entry.
• Provide supplies such as alcohol-based hand rub (ABHR) with 60-95% alcohol, tissues, and no-touch receptacles for disposal, in the waiting room, and at the front desk.

Measures Upon Arrival

Patients are:

• Immediately asked to use hand sanitizer
• Asked about their presence of symptoms of respiratory infection and history of travel or contact with possible COVID-19 patients
• Assessed for respiratory symptoms and fever (with a non-contact digital infrared forehead thermometer) and they will be asked to sign a health declaration form.
• If fever temperature of 100.2 degrees F or higher or respiratory symptoms are present, they will be advised to seek medical treatment and their visit will be rescheduled
• As testing for the virus becomes more available, we will be incorporating this added benefit to screening patients

Measures Taken Upon Patients’ Entry to the Clinical Area

• If an examination room is not readily available, ensure social distancing in the waiting room by placing seating a minimum of 6 feet apart.
• Remove all clutter and anything that is not easily disinfected from the waiting room (magazines, area rugs, pillows, toys, etc.)
• Frequent wipe down of waiting rooms, bathrooms, door handles, tables, light switches, computers…etc.

Reception Room and Front Desk Safety Measures

• Install physical barriers or partitions (e.g. glasses or plastic windows) if possible, at reception areas to limit close contact between reception and potentially infectious patients.
• Headphone use is encouraged, so hands are free and only one person uses it.

Protocols of the Clinical Team

We adhere to usual standard and transmission-based precautions in operatory but with greater attention to detail and ensure that procedures are followed consistently and correctly.

Appointments will be categorized as low risk, medium risk and high risk for creation of an aerosol. 

Hand Hygiene is performed by our staff – for all risk categories

• Before and after all patient contact, contact with potentially infectious material, and before putting on and after removing PPE, including gloves.
• After removing PPE in order to remove any pathogens that might have been transferred to bare hands during the removal process.
• Washing hands with soap and water for at least 20 seconds.

Personal Protective Equipment – dependent upon the risk for creation of an aerosol

• Wear PPE (masks, gloves, cap, eye protection, face shields, gowns)
• N95 respirators should be used instead of a facemask when performing or present for an aerosol-generating procedure.

Eye Protection

• Put on eye protection (i.e., googles or a disposable face shield that covers the front and sides of the face) upon entry to the patient room or care area.
• Remove eye protection before leaving the patient room or care area.
• Reusable eye protection (e.g., goggles) must be cleaned and disinfected according to manufacturer’s reprocessing instructions prior to re-use

Gloves

• Put on clean, non-sterile gloves upon entry into the patient room or care area.
• Change gloves if they become torn or heavily contaminated.
• Remove and discard gloves when leaving the patient room or care area, and immediately perform hand hygiene.

Gowns – for high risk procedures

• Put on a clean isolation gown upon entry onto the patient room or area.
• Change the gown if it becomes soiled. Remove and discard the gown in a dedicated container for waste or linen before leaving the patient room or care area. Disposable gowns should be discarded, and cloth gowns should be laundered after each use.
• Gowns should be prioritized for all aerosol-generating procedures and during activities where splash and sprays are anticipated.

Shoe Covers – for high risk procedures

• These will be worn over running shoes unless staff is wearing plastic shoes that can be wiped down and disinfected.

Patients in the Operatory

• Health care personnel (HCP) should strictly follow basic infection control practices between patients (e.g., hand hygiene, cleaning and disinfecting shared equipment)
• Limit transport and movement of the patient outside of the room
• Minimize other team members from entering the room during a procedure and if necessary, should use PPE described above.
• Room doors should be kept closed except when entering or leaving the room, and entry and exit should be minimized.
• Once the patient has left the operatory, HCP refrain from entering the op until enough time has lapsed to remove potential infectious particles.
• After this time has elapsed, the room should undergo appropriate cleaning and surface disinfection before it is returned to routine use.
• Special precautions will be taken when performing Aerosol Generating procedures (AGP) procedures that are likely to induce coughing area avoided if possible.
• Patients undergoing aerosol-generating procedure are in rooms 2 or 3
• The Recirculator II Air Purification system will be in use in rooms 2 and 3 while aerosol producing procedures are carried to clean the air of the operatory. This is a proven hospital grade system that was developed for airborne diseases like threats like COVID-19.

Protocols After the Clinical Treatment

• All non-disposable medical equipment used for patient care should be cleaned and disinfected according to manufacturers’ instructions
• Ensure that environmental cleaning and disinfection procedures are followed consistently and correctly.
• Routine cleaning and disinfection procedure (e.g., using cleaners and water to pre-clean surfaces prior to applying an EPA-registered, hospital-grade disinfectant to frequently touched surfaces or objects for appropriate contact times as indicated on the products label) are appropriate for SARS-CoV-2 in healthcare settings, including those patient-care areas in which aerosol-generating procedures are performed.

Safety Measures After the Visit

• Encourage payment by E-Transfer, Pay Pass or credit card over the phone to encourage social distancing with front desk.
• Review of estimates and insurance forms can be carried out via phone call or video conference and sent via mail

At the End of the Day

• The entire office will be cleaned at the end of the day to make sure it is ready for the patients treated during the next day

WE ARE CONFIDENT THAT THESE GUIDELINES WILL HELP TO CREATE A SAFE ENVIRONMENT FOR ALL OF OUR PATIENTS AND TEAM MEMBERS AND HOPE THAT YOU CAN FEEL SECURE IN THE KNOWLEDGE THAT WE ARE DOING EVERYTHING IN OUR POWER TO PROVIDE THE SAFEST CLINICAL CONDITIONS IN ODER TO PROTECT OUR PATIENTS, OUR TEAM AND OUR FAMILIES.