Public Health Order 20-29 was amended by CDPHE and released this afternoon. This order provides some clarification and modifies text of the original order that was released on April 27. The CDA submitted comments to the health department and met with officials last week to voice concerns about the restrictions on aerosolizing procedures during the Safer at Home phase of state recovery.
The CDA is grateful that most of our advocacy efforts resulted in a direct impact on the health department’s decision to permit several aerosolizing procedures while achieving the safety goals that the state and the CDA remain focused on during this pandemic.
Key highlights in the amended version include:
- A revision of priorities in Section II for the resumption of voluntary/elective procedures.
- A requirement that offices have a formal plan (as well as already existing guidelines) to ensure adherence with the principles outlined in the order.
- Expanded requirements around facility reassessments every two weeks.
- A revision of protocols for dentists treating patients with and without COVID symptoms.
Aerosolizing Procedures
The substantial change for dentists in this order concerns the ability to provide non-emergent services, including limited procedures that generate aerosols:
viii. “The dental Facility must appropriately schedule patients, so that providers have sufficient time to change PPE, to ensure office and equipment can be cleaned and disinfected between each patient, to allow for aerosolized particles to settle, and to minimize aerosol contamination generally.”
- “For non-symptomatic patients, the dental Facility must seek viable options for reducing or containing aerosol production during care. Aerosol generating procedures should only be performed when using PPE as outlined in Section III.A.2.i of these guidelines, which requires the use of enhanced PPE, consistent with PPE guidelines from OSHA and CDC for treating COVID-positive patients that offers increased protection to patients. The use of dental instruments that are known to generate aerosols are not allowed for dental cleanings.”
Under the Public Health Order, limited aerosolizing procedures in non-symptomatic patients are allowed IF the dental office has appropriate and adequate PPE, which must include:
- a face shield or goggles
- an N95 or higher respirator*
- clean non-sterile gloves
- an isolation gown
- a bonnet or hair cover
- booties or shoe covers
*Alternatively, a face shield or goggles and a level 3 surgical mask may be used as an acceptable alternative if an N95 mask is not available.
Some offices have expressed concern over finding disposable gowns, bonnets and booties. The purpose of these items is to protect yourself from aerosol droplets that will land on your body, head and feet.
Local Orders
Several local government orders extend the stay-at-home deadline for their residents. However, it has been confirmed by the governor’s office and county public health agencies that local municipalities do not have the authority to issue directives for voluntary/elective medical procedures.
Therefore, dentists may open their offices for dental treatment in alignment with the current Executive Orders and recently amended Public Health Order 20-29.
Colorado Counties, Inc. has published a helpful map that displays local orders. Click on a county to see relevant information.
Submit Comments to the State
CDPHE is accepting comments regarding the Public Health Order. Comments should be constructive and can be submitted at: covid19.colorado.gov/CovidConcerns.