How to manage COVID-19 restrictions with the least possible financial impact for your practice? The latest CDO letter to dentists, and its first 24th July deadline, means decisions around Coronavirus measures are now unavoidable.
Ryan Devenish of Global Dental – a leading UK supplier of dental practice design, fit-out, equipment and maintenance – outlines some answers to the biggest challenges now facing the UK dental industry, including:
• A better approach to ‘sneeze screens’ for lasting, aesthetically pleasing results
• An effective way to reassure patients a practice has been sanitised
• A vital check practices should carry out and a ventilation step practices can take to drastically reduce their ‘fallow’ time.
Coronavirus and Dentistry: Getting Back to Normal
Ryan, who has been in daily contact with dentists throughout the outbreak, said he was impressed with how “a lot of companies that are rapidly and entrepreneurially creating products designed to enable our dentists get back to work normally and as soon as possible”.
“It has also been really interesting to see and hear so many different views and opinions on what is going to “sort” this challenge that dentists have.”
He began his overview of the essential issues with a vital consideration: PPE.
1, Coronavirus and Dentistry: PPE and Practice Infrastructure
“Personal Protective Equipment and protective infrastructure are going to be the first line of defence for all clinicians working in the dental environment. Thankfully the supply is clearly getting better every day, and really it will only be a matter of a brief period of time before supply gets back on top of demand and the products all start to become more sensibly priced again.
“Perhaps the easiest risk to eliminate and, as we’ve been advised by the government, is to provide a screen for the staff team sitting at the desk.
“I’ve been to countless practices where bits of polythene, and slabs of plastic, are totteringly precariously on the counter top. Not just unsightly but brings a risk of the ‘screen’ topping onto a practice reception colleague. Also, some of the screens I've seen, due to the materials used, are unlikely to withstand being cleaned with alcohol wipes and, therefore, will discolour and become brittle quickly.
“A better solution? Install a professional, bespoke glazed screen that can be kept in place indefinitely, but also removed in the future, as we’ve been led to expect this probably won’t be the last virus that comes across our paths.”
2, Coronavirus and Dentistry: Surface Sanitising
“Surface sanitisation is extremely important, misting or electrostatic fogging is by far the most effective method of ensuring all surfaces are reached. This said, however, generally nurses are really effective at wiping down equipment, and largely would reach the vast majority of the regularly used surfaces.
“But if it’s the real peace of mind you’re looking for, being able to really convince your patients you are doing everything you can then some form of fogging or misting could be worth exploring.”
3, Coronavirus and Dentistry: Aerosol Control
“There’s no getting away from the issue of aerosol control - from it, in fact - and even Boris Johnson mentioned in a recent press conference that the dental environment does indeed experience more than its fair share of risk primarily from aerosols.
“Right from the actual high-speed turbine and scaler right through to the family of five coughing and spluttering at the desk, there are a lot of aerosols being circulated all over a practice.
“Then comes the hugely challenging problem of aerosols generated from dental procedures. I’ve been amazed at the variety of products that sprung up to help the dentists combat this problem.
“The overriding point I suppose is the fact that no measure can remove the risk, all measures of risk mitigation. So once again the balance of cost and mitigation does rear its somewhat ungainly head.
“For those that want to invest in being the safest they can, we are promoting the Dental Ex extra-oral suction machine, and there are a number of fixed installations we can also offer.
“We believe that the most effective solution is a relatively low cost two-pronged attack based around existing high volume suction and ventilation of rooms.
“The high-volume suction that the majority of treatment centres will have access too is really effective at removing a good majority of aerosol as that is what it was designed to do.
“So – vitally - have your suction checked over! It should be 300 litre/min at the chairside.
“Its scary over the recent checks we’ve been doing for clients how low suction clinicians have been working with. And the good thing is there’s so many minor tweaks that can be done to improve this incumbent system.”
4, Coronavirus and Dentistry: Fresh Air Ventilation
“Fresh air ventilation, a largely overlooked system in dentistry but in a perfect world should be in every commercial setting. After all, Public Health England state that a single air change is estimated to remove 63% of airborne contaminants while after five air changes less than 1% of the original airborne contamination is thought to remain.
“I’m sure everyone has witnessed the cool yet fresh atmosphere of a high spec office environment with proper filtered fresh air supply and extraction of the stale air. What’s more there’s normally a heat recovery system involved which recycles heat and reduces running bills.
“So the advice from the NHS stipulates that after a AGP the operating room must be left for one whole hour as “fallow”. This means for a 40 minute appointment on standard hours you’re looking at six patients a day.
“However, if you can create negative pressure in the room that fallow time can be reduced to 20 minutes, which equates to an additional two patients an day increase of 33% which equates to a significant financial throughput increase.
“Negative pressure sounds a simple term and in essence the principle is simple: remove more air than is coming into the room. Its clear that opening a window does not create negative pressure as air can gust in and out. There is a huge area of study around negative pressure and how to achieve it effectively but I think it’s fair that in this context the simple process of removing the air quickly from the room is sufficient.
“There’s a wide selection of options available in ventilation and we’ve started by bringing quickly to market a temporary ventilation system that can sit quietly and efficiently in a surgery. See our website for details.
“Longer term, there’s a range of permanent ventilation installations that can not only make the air nicer to breath and work in, but can also reduce heating bills and ensure the air remains safer for patients and clinicians alike. “