COVID-19 Update

Dear Valued Patients,

Our community has been through a lot over the past few months, and all of us are looking forward to resuming our normal habits and routines.

While many things have changed, one thing has remained the same: our commitment to your health and safety. Given the current environment with Covid-19, we have made some physical changes to the office, along with some additional protocols and infection control measures, to ensure your health and safety and that of our team. Here is a detailed overview of the safety measures in our dental practice:

Physical Changes to Our Office for Added Safety Measures

We have made some physical changes to our office for added safety measures. Some are obvious and others are unseen, but in total they are meant to help create a safer environment for our patients and staff.

UV-C Non-Ozone Generating Air Filter

• We have placed HEPA air filtering units in all our operatories and reception area along with upgrading to MERV 13 air filters in our ventilation system.
• We have installed two UV-C light air purification/filtration devices in our ventilation system, to kill viruses, bacteria and other pathogens, similar to what are used in hospitals and the International Space Station.
• We have placed high volume extra-oral evacuation suction units in all our operatories to assist in capturing aerosols not caught by the high volume intra-oral suction devices that we normally use when treating our patients.
• Sneeze guards have been installed in our reception desk area to limit contact between reception and potentially infectious patients.
• Reception room and all clinical areas have been cleared of all magazines, toys, decorations and displays that are either difficult to clean, or might be touched and handled by multiple people.
• We have placed hand sanitizer stations, along with easy access tissues and waste baskets in multiple locations throughout the office.

Training and Educating Our Team

Dr. Frey and all the staff, both clinical and in the reception area, receive bi-annual training in infection control as mandated by the State of California. We are all certified by the American Heart Association in Basic Life Support (CPR and AED use). We have an AED in the office. There are few safer places to be than in a dental office. We have also instituted the following measures as part of our training and education:

• All staff have participated and practiced the appropriate use of personal protective equipment (PPE) prior to caring for a patient to prevent contamination.
• All staff have received a mandated Occupational and Safety Hazard (OSHA) N95 mask fit training.
• Everyone in the office is asked a series of Covid-19 health screening questions and has their temperature taken at the beginning of every day. We will immediately send home anyone with an elevated temperature (100.2F and above).
• We encourage staff who are not feeling well to proactively stay home for two weeks.
• We limit the number of staff providing care to facilitate social distancing within the office and among team members. Staff take their breaks outside, or in their cars to maintain physical distancing.
• We have a separate clean room where staff can change in and out of their personal clothing and shoes and into their clinical attire.
• We have created a special checklist of recommendations for our team to follow, so they arrive to work healthy and go home to their families without worry.

Recommendations for Our Team

Before coming to work

• Take temperature (do not go to work if you or your family member are experiencing symptoms; cough sore throat fever…etc.). All staff will have temperatures taken when they arrive in the office each morning, and will be screened for Covid-19 symptoms and the results logged.
• Rings and watches should be smooth and cleansable, otherwise leave at home.
• Tie up hair, keep nails short.
• Avoid extra accessories.
• Place phones in Ziplock bags that you will discard at the end of the day.
• Have work shoes you leave at the office preferably plastic and wipeable with disinfectant.
• Bring work clothes in a washable bag ( i.e. pillowcase)
• If bringing a lunch, place in disposable wrapping

At work

• Change into scrubs and work shoes as soon as you arrive. Place personal belongings in a closet, cabinet or sealed bag to reduce exposure of these items.
• Leave all clutter (pens, phones, etc.) outside of patient op rooms. Place them in cabinets or drawers.
• We discourage workers from using other workers phones, desks, offices, and other work tools and equipment when possible.
• Clean phone handset after use. Hospital-grade wipes and trash receptacles will be by all phones.
• Do not share creams, lotions, and other cosmetics

After work

• Wash hands and arms with soap.
• Remove work shoes and scrubs. Disinfect shoes left at office. Place scrubs in bin to be laundered on site.
• Wash hands and put clean clothes and shoes and clothes on.
• Sanitize phone glasses, etc.
• Wash hands again

At home

• Wipe down car steering wheel, door handle, gear shift, radio, seat.
• Remove street clothes and shoes and put clothes in laundry, or in sealed /washable bag to launder later.
• Shower immediately with soap & water before touching anything especially loved ones).

Patient Interviews and Social Distancing

Before patient arrival every effort is made to:

• Filter patients during phone call when scheduling appointments for care using established and recommended screening checklists and scripts. Ask them to arrive with their own mask and pens for signing documents. Inform them of the procedural changes they can expect when they arrive at the office.
• Reschedule patients who show any signs of a cough, or fever or describe having any warning signs.
• Instruct patients to call ahead and reschedule their appointment if they develop symptoms of respiratory infection (eg. cough, fever, sore throat…) on the day of their appointment.

Promote Social Distancing

• Prioritize high risk patients (immune compromised, over age 60, diabetes, etc.) with early morning appointments so less contact with others.
• When booking patients spread out the schedule so there are less people in the office at any given time. Patients may have to wait in their cars or outside the front door. Ideally, only two patients at a time, three if a double hygiene day. Schedule so they don’t all finish at same time. Only one person checking out at front desk at a time.
• If patient is being accompanied, their escort should wait in the car. Only one parent will be allowed to enter the office with a child. Parents should please avoid sending grandparents or guardians over the age of 60 (high risk groups), to accompany a child. Supply a mask and shield to anyone who accompanies the patient if they don’t have one.
• Utilize “virtual” waiting room: patients can fill out registration forms in their cars or chairs outside the office where they can be contacted by mobile phone when it’s their turn to be treated.

Additional safety measures

• Visual alerts (signs and posters) are posted at entrance to front door advising patients of the COVID-19 risk and advising them not to enter the facility if feeling ill. Visual alerts should also provide instructions about hand hygiene, respiratory hygiene and cough etiqutee
• Masks and tissues made available near entry to every patient and instructions provided on how to use tissues to cover nose & mouth when coughing or sneezing, to dispose tissues and contaminated items into waste receptacles.
• Limit points of access to the office. All interior doors left open to avoid contact with door handles
• All keyboards and mice covered with plastic saran wrap. Place charts under vinyl coverings on back counter of treatment areas.
• Wrap x-rays with chair covers.
• On regular basis wipe all touchable surfaces, including chair arms, door handles, tables, light switches, bathrooms hangers and anything else people come in contact with.

Measures Upon Arrival and During Clinical Treatment

• Upon arrival patients should call to let us know they are here. Pre-screening questions should be asked over the phone. They can wait in their cars or come sit outside the front door. Their temperatures can be taken outside while they are waiting, or at the time we are ready to bring them in.
• If patients have already filled out their forms, collect them from their cars, or have them bring the forms to the door. If they need forms, they can come to the door and get them and fill them out outside, preferably with their own pen.
• Immediately upon entry they should be escorted to a hand washing station (eg bathroom or hand sanitizer area).
• Patients should sign pre-screening form, then be escorted into the operatory as quickly as possible to avoid lingering in front office.
• As point-of-care testing for the SARS-CoV-2 virus becomes more available, we will incorporate this added benefit to screen patients and staff.
• Clinical staff should wash their hands, then don masks, eyewear and gowns before escorting the patient to the operatory. Drape the patient, review medical history, then wash hands, glove, wear face shield and proceed with treatment.
• Both high speed intra-oral and extra-oral evacuation should be used simultaneously when performing any aerosol generating procedure.
• Limit transport and movement of patient outside the treatment room.

Protocols After Clinical Treatment

• Remove gloves, face shield, wash hands and schedule patient for next visit either at work station, or escort to front desk. Remove gown gown (if reusable gown, place in laundry bin in operatory), wash hands, re-glove and proceed to clean room.
• Clean operatory. Drain all water lines for 2 minutes. Remove all disposables, including plastic wrap on keyboards & mice. Spray and/or wipe all surfaces with hospital-grade surface disinfectant including counter tops, bracket tables, x-ray units cabinet handles, chair arms etc. Re-usable face shield inserts should be replaced and dirty one placed in disinfecting solution. Take instruments to sterilization room. Remove mask and replace if dirty or worn, or place in UV-C disinfecting unit for re-use later. Put on new mask.
• While room is decontaminating, wash hands and write up chart notes in consultation room, or other area outside operatory.
• Once appropriate disinfectant times have been met, prepare room for next patient by covering all touch contact points with disposable barriers, including x-ray heads, keyboards, and chairs. Bring in a tray with sterilized bagged instruments for the next procedure.