CDPHE released the eighth amended Public Health Order that impacts dental procedures and treatment.
Read the latest version of PHO 20-29.
The latest revision of PHO 20-29 reordered several sections and added verbiage throughout the order. The additions that pertain to dentistry were not overly concerning but the CDA encourages you to read the PHO in its entirety. The CDA receives numerous calls each day and much of the information to address these calls and questions can be found in this document.
Again, please read PHO 20-29 in its entirety and note the following highlights:
- On page 2, a new section was added for hospitals and hospital-owned ambulatory surgical centers. While this new section does not apply to the vast majority of dentists, it may be of interest to read in addition to the Appendix A chart on page 24.
PPE and Infection Control
- In past PHOs, it has always been recommended that providers have a two-week supply of “recommended PPE” without the need for emergency PPE-conserving measures. The new version of the PHO defines that recommended PPE as, “facemasks or N95 respirators, eye protection (face shield or goggles), gowns, and gloves.” It also added that, “If the workforce is to use N95 respirators for direct patient care, fitting and additional training on how to perform a seal check must be completed prior to use.”
- In regard to extending the use or reuse of PPE, additional guidance was added: “If a Facility proposes to extend the use of or reuse of PPE, it must follow Centers for Disease Control and Prevention (CDC) PPE optimization strategies and monitor the continuous availability of supplies. Facilities should promptly resume standard practices as PPE availability returns to normal and encourage appropriate use by staff, visitors, and patients. Additional information on PPE and appropriate use can be found here.“
- A link was provided for easy access and reference to local health departments for reporting purposes.
- Language was added that, “All staff should wear a facemask at all times while they are in the facility, which covers both their nose and mouth.”
- Concerning engineering and process controls in break rooms and common areas, “opening a window” was added as a possibility. In reference to fans, “Caution should be utilized if considering the use of fans. Consult CDPHEs COVID-19 Ventilation Guidance before use.”
- A section was added regarding education and supplies for respiratory hygiene and cough etiquette:
“The medical Facility should ensure adequate education and supplies for respiratory hygiene and cough etiquette for staff, visitors, and patients at entrances and throughout the facility.
– Make tissues and cloth face coverings (or facemasks) available for coughing people. (Prioritize facemasks for healthcare personnel.)
Ensure adequate hand hygiene.
– Provide hand hygiene products for staff and patient use, placing alcohol-based hand sanitizer with 60-95% alcohol throughout the facility and preferably both inside and outside of each treatment room.
– Make sure that sinks are well-stocked with soap and paper towels for handwashing.”
Patient Screening
- In regard to patient screening, it is recommended that patients not only be asked about symptoms but also of possible exposures: “The dental Facility must implement a universal symptom and exposure screening process for all staff, patients and visitors. Necessary screening includes, at a minimum, asking about any known exposure and for recent history of fever (≥100.4°F) or chills, cough, shortness of breath, difficulty breathing, fatigue, headache, new loss of taste or smell, sore throat, congestion or runny nose, muscle or body aches (myalgia), nausea, vomiting, or diarrhea.”
- This section is not new but due to increased COVID-19 numbers, the CDA would like to remind you to be aware of and practice this: “Even when dental health care providers screen patients for exposure and COVID-19 symptoms, inadvertent treatment of a dental patient who is later confirmed to have COVID-19 may occur. To address this, dental health care providers should request that the patient inform the dental clinic if they develop symptoms or are diagnosed with COVID-19 within two (2) days following the dental appointment.”
Definitions
- Under the definitions section of the PHO, “individuals who are immunocompromised (weakened immune system) from solid organ transplant;” “individuals who are pregnant;” and “individuals who smoke” were added to the list of “Individual at Risk of Severe Illness from COVID-19.”
This version of PHO 20-29 will expire 30 days from Nov. 13, 2020 unless extended, rescinded, superseded or amended in writing.