Penn Dental Medicine COVID-19

Infection Control Policy & Protocol October 21, 2020

Purpose: To reduce the risk of exposure to contagious agents that are spread by droplet contact, such as the coronavirus SARS-CoV-2, by expanding on our current infection control procedures which are based on “Standard Precautions”. The goal of these new measures is to mitigate risks and protect our faculty, staff, students, and patients. This includes the use of proper Personal Protective Equipment (PPE) in all patient encounters including, but not limited to, the management of aerosol producing procedures. This protocol should allow for a gradual return to “normal operations” and the continuation of providing a reasonable level of care and services to our patients and our community at large. We will continue to monitor recommended updates by official bodies such as the CDC, OSHA, and ADA and update our protocols accordingly. Scope: This protocol applies to all faculty, staff, students, patients, visitors and vendors of Penn Dental Medicine (PDM). Definitions: PPE: According to the U.S. Occupational Safety and Health Administration, wearing appropriate personal protective equipment (PPE) can significantly reduce risk, since it acts as a barrier against exposure. Personal protective equipment may include gloves, gowns, laboratory coats, face shields or masks, eye protection, and other protective gear. The PPE selected must be appropriate for the task. The CDC promotes patient safety and the increase in the safety of the healthcare work environment through improved use of PPE by healthcare personnel. CDC PPE for Protecting Healthcare Personnel Infectious Diseases: According to the U.S. Department of Health and Human Services and the World Health Organization, infectious diseases are caused by a microorganism, such as a bacterium, virus, or protozoan, that is not normally found in the body and is capable of causing infection. Some, but not all, infectious diseases are contagious, meaning they can spread from person to person. Zoonotic diseases are infectious diseases of animals that can cause disease when transmitted to humans. Infectious Diseases Social Distancing: also called “physical distancing,” means keeping space between yourself and other people outside of your home. To practice social or physical distancing:

• Stay at least 6 feet (2 meters) from other people

• Do not gather in groups

• Stay out of crowded places and avoid mass gatherings Social Distancing

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Aerosol Procedures: Some procedures performed on patients with an infectious disease, including suspected COVID-19, could generate infectious aerosols from saliva, blood, or tissue. An infectious aerosol is a collection of hidden pathogen particles in the air, such as viruses and bacteria. Aerosol particles may “deposit onto” or be “inhaled by” a susceptible person. Aerosol transmission is likely to occur when:

• Infectious aerosols are generated by or from an infected person

• The virus/bacteria remain viable in the environment for some period

• The tissues in which the bacteria/virus initiates infection are accessible to the aerosol Aerosol and Transmission of Infectious Disease

Additional CDC recommendations and precautions for Aerosol Procedures can be found by clicking this link: CDC Interim Infection Prevention and Control Recommendations Policies & Protocols: General:

• PDM will be following CDC recommendations for risk assessment of faculty, staff, and students, as published in the “Interim U.S. Guidance for Risk Assessment and Public Health Management of Healthcare Personnel with Potential Exposure in a Healthcare Setting to Patients with Coronavirus Disease (COVID-19)” CDC Guide

o This CDC document is intended to assist with assessment of risk, monitoring, and work restriction decisions for healthcare providers with potential exposure to COVID-19.

• All faculty, staff, and students MUST self-assess their health DAILY including on days they are not planning to be at PDM as well as on weekends. They MUST respond “No” on PennOpen Pass to all the following screening questions and receive a green pass to be allowed on site:

o Fever >100.0o F

o Cough

o Sore throat

o Shortness of breath

o Flu-like symptoms, Muscle ache, Chills, Tiredness

o Diarrhea

o Nausea or vomiting o Headache

o Congestion of runny nose

o Recent and abrupt loss or reduction of the sense of smell and/or taste

o Close personal contact (without PPE) with a suspected or laboratory-confirmed COVID-19 patient in the past 14 days CDC Definition of Close Contact

Honest self-assessment of health and exposure protects YOU, YOUR FAMILY and OTHERS from exposure to the COVID-19 virus and to other communicable diseases. If you do not meet the above criteria, DO NOT come to the school of Dental Medicine for ANY REASON

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• Faculty and staff who answer YES to any of the questions mentioned above MUST indicate it on

the PennOpen Pass and notify their supervisor and follow CDC recommendations in the guide above by not reporting to work. They will receive a RED pass. Employees who receive a red pass will not be permitted onsite and will be contacted by someone from PennOpen Pass and must follow their instructions. For additional information on COVID related and testing information please visit PennOpen Pass.

• ALL supervisors are to report the employee notification to the Office of Clinical Affairs, Dr. Najeed Saleh and as a back-up Office of Academic Affairs, Dr. Faizan Alawi.

• Students and residents who answer YES to any of the questions mentioned above MUST also

indicate it on the PennOpen Pass and notify the Offices of Student Affairs, Academic Affairs and Program Directors and follow CDC recommendations in the guide above by not reporting to PDM. They will receive a RED pass. Students and residents who receive a red pass will not be permitted onsite and will be contacted by someone from PennOpen Pass and must follow their instructions. Students must follow up with Campus Health Services 215-746-3535 and present an attestation from Campus Health that they may return to PDM.

• Students and residents MUST continue to observe University directives published on Student Campus Compact

• Entrance to PDM will be controlled by lanes for faculty, staff, students, residents, patients, vendors, and visitors. ALL faculty, staff and students will arrive wearing masks and follow social distancing while waiting to enter the building.

• Entrance to PDM premises ANYTIME of day or night acknowledges that you have answered NO to the following questions:

o Fever >100.0o F

o Cough

o Sore throat

o Shortness of breath

o Flu-like symptoms, Fatigue, Muscle ache, Chills

o Diarrhea

o Nausea or vomiting o Headache

o Congestion of runny nose

o Recent and abrupt loss or reduction of the sense of smell and/or taste

o Close personal contact (without PPE) with a suspected or laboratory-confirmed COVID-19 patient in the past 14 days

• Faculty and staff will use the main entrance on 40th street thru the door on the left (South) and will continue thru the faculty and staff lane.

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• Patients will use the middle doors on 40th street to enter the building and will be directed thru the middle lane.

• Right (North) door will be used by all for Exit only.

• Patients will use the Spruce Street exit, unless they are required to check out with PFS.

• Patients with disabilities will use the 40th Street exit.

• Students and residents must use the Evans side garden entrance, in the lower concourse, accessed thru Preston Street.

• Body temperature WILL be measured on all individuals entering PDM, including faculty, staff, students, residents, patients, visitors, and vendors. Those with body temperature of 100.0o F or above will be turned away.

o If a patient has a fever strongly associated with a dental diagnosis (e.g., pulpal and periapical dental pain and intraoral swelling are present) but no other symptoms consistent with COVID-19 are present, dental care can be provided following the practices recommended for infection prevention and control practices for routine dental healthcare delivery during the pandemic.

• All faculty, staff, students, patients, visitors, and vendors MUST undergo screening AND be wearing masks at all times while they are at PDM. Removal of masks is permitted for patients during treatment, and for faculty, staff and students while dining.

• All faculty, staff, students, patients, visitors, and vendors must observe social distancing at all times except for patient care.

• Additional dining areas will be established in the Dean’s courtyard and outside the Schattner pavilion to be utilized with appropriate social spacing. Dispose of garbage in designated receptacles, and spray and wipe area you used with provided antimicrobial agent.

• All patient appointments must be scheduled in advance by staff, students, residents, or by calling the call center at 215-898-8965. NO walk-in patient can be accepted due to limitation on building occupancy and patient spacing requirements. This applies to urgent care patients as well.

• All patients MUST be reminded to arrive wearing a mask or receive one at the door. Patients will be screened with the above screening questions upon scheduling, day before appointment, appointment confirmation (thru Intiveo), upon arrival at PDM, and again by the provider prior to commencing with treatment.

• All patients MUST be triaged by telephone the day before their appointment and asked the above screening questions to assess their risk of having contracted COVID-19. They must be reminded to use precautions while traveling to and from their appointment.

• Patients with a YES answer to any of the above screening questions MUST be triaged via Telephone or Tele-Dentistry, involving videoconferencing. Those with YES answers who are

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scheduled to resume with their elective dental care MUST be advised to defer current dental treatment and contact their Primary Care Physician, and to self-quarantine for 14 days prior to scheduling another appointment. Patients with an emergent care need, such as uncontrolled bleeding, swelling, or facial trauma, MUST be directed to Oral Surgery or to the closest ER as per our after-hours emergency care policy: PDM Afterhours Emergency Policy

• Patients who pass the entry screening MUST clean their hands with hand sanitizer after which time they will be directed to their designated treatment clinic to proceed with their dental care. They MUST continue to wear their masks and observe social distancing throughout their presence at PDM except during the time of active treatment.

• Seating in patient waiting areas will be reduced to allow for appropriate social distancing. Patients who cannot be accommodated in the waiting area will be asked to provide their cell number and leave the building until they receive a text/call once they could be seated. Appointments MUST be scheduled so patients have minimal waiting time.

• Patients are permitted to be accompanied by ONE supporting individual who is absolutely essential to the patient’s visit such as a parent, guardian, etc., (accompanying individuals deemed non-essential will be asked to leave PDM). PDM screening rules do apply to these individuals as well and if answering YES to any of the screening questions the visitor MUST be turned away. Those who pass the PDM screening are welcome to stay in one of the waiting areas and MUST continue to wear a mask at all times as well as continue with social distancing.

• People with COVID-19 who have completed home isolation are eligible to receive dental care following PDM infection control protocols based on CDC guidance: Discontinuation of Isolation for Persons with COVID-19 Not in Healthcare Settings

Persons with COVID-19 who have symptoms and were directed to care for themselves at home may discontinue isolation under the following conditions:

• At least 10 days* have passed since symptom onset and • At least 24 hours have passed since resolution of fever without the use of fever-reducing

medications and • Other symptoms have improved.

*A limited number of persons with severe illness may produce replication-competent virus beyond 10 days, that may warrant extending duration of isolation for up to 20 days after symptom onset. Consider

consultation with infection control experts. See Discontinuation of Transmission-Based Precautions and Disposition of Patients with COVID-19 in Healthcare Settings (Interim Guidance).

Persons infected with SARS-CoV-2 who never develop COVID-19 symptoms may discontinue isolation

and other precautions 10 days after the date of their first positive RT-PCR test for SARS-CoV-2 RNA.

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PPE Requirement: The following PPE is required for treating patients at PDM: - Full length disposable gowns - Booties/shoe cover - Bonnet head cover - N95 (or suitable substitute e.g. Elastomeric Respirator, or PAPR) - Goggles/loupes - Full surgical face shield - Gloves Note:

1. One N95 mask (or equivalent) will be dispensed once every two weeks to every student, resident, faculty, and staff involved in direct patient care. Masks could also be replaced when soiled or damaged.

2. N95 masks will go through sterilization process approved by the FDA to extend the use of N95 masks and to help maintain inventory of N95 masks available for patient care. You will continue to wear the N95 mask per current protocol and turn the mask into clinic instrument collection windows for sterilization processing. Each wearer must follow these steps prior to turning in your mask for sterilization.

a. Clearly print your name, first and last, on the outside of the N95 mask with a black sharpie.

b. Write the PDM site location code on the mask: CO2 c. Print your home clinic name on the mask: i.e. Perio, Endo, Ortho, Pedo, Shils,

Schattner, Oral Surgery, MCC, LW, UC, ADCC. This information is needed to identify your mask and to ensure return of masks to PDM for redistribution.

3. The need for and the fitting of the N95 masks or their equivalents will be conducted/determined by Penn Environmental Health and Radiation Safety (EHRS).

4. N95 masks MUST be stored in provided paper bags when not in use. You MUST label the bag with your name (do not place in scrub pockets or put weight on masks). Surgical mask MUST be worn at all times. The following video provides helpful tips on how to safely use and reuse face masks/respirators: Use and Reuse of Face Masks

5. One face shield will be dispensed daily to all involved in direct patient care. Shields MUST be wiped with antimicrobial agent between patients and discarded at the end of each day.

6. PPE cannot be adjusted (retying gowns, adjusting N95 mask, etc.) once patient care has commenced. Ensure all PPE are properly donned before entering treatment room.

7. ASTM 1 surgical face mask MUST be worn over the N95 mask (or equivalent) at all times during patient care.

8. Gowns, gloves and facemasks MUST be changed between patients after aerosol procedures. 9. All personal items e.g. jewelry, cell phone, wrist watches, etc. MUST be removed before putting

on PPE.

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10. Hair MUST be properly tied back and kept under head bonnet. It is recommended that mustache and beard be shaved to allow for proper fitting of N95 mask. CDC Using Personal Protective Equipment (PPE)

Donning (putting on the PPE):

1. Identify and gather the proper PPE to don: Inspect your equipment for any damage prior to donning each piece.

2. Put on your shoe covers (booties): Make sure that all areas of the foot are covered, and the shoe

covers are snug over your ankle and calf. Try not to touch the floor or other areas with your hands while putting the shoe covers on.

3. Perform hand hygiene using hand sanitizer or soap and water if hands are visibly soiled (wash

for at least 20-30 seconds). CDC Hand Hygiene in Health Care Setting

4. Put on clinical gown. Tie all of the ties on the gown.

5. Put on a head cover (bonnet). All hair must be tied back tucked under head cover and/or gown at all times.

6. Put on N95 respirator. If the respirator has a nosepiece, it should be fitted to the nose with both

hands, not bent or tented. Do not pinch the nosepiece with one hand. Respirator should be extended under chin. Both your mouth and nose should be protected.

a. Respirator: Respirator straps should be placed first at the base of the neck (bottom strap),

and second on the crown of the head (top strap). Ensure good fitting and perform a user seal check each time you put on the respirator.

b. Cover respirator with an ASTM 1 surgical mask.

7. When placing an N95 mask which was previously used you MUST place gloves first and follow the procedure above. Remove gloves and perform hand hygiene before you continue with donning the rest of your PPE.

8. Put on Goggles or loupes.

9. Put on face shield: Face shields provide full face coverage (the top of the face shield should be

resting in the middle of the forehead).

10. Perform hand hygiene before putting on gloves. Gloves must cover the cuff (wrist) of gown. Doffing (removing the PPE):

1. Remove contaminated gloves. Ensure glove removal does not cause additional contamination of hands. Gloves can be removed using more than one technique (e.g. fold and tuck or double fold

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techniques). Perform hand hygiene at this time if there is any concern your hands became contaminated during the glove removal. If double gloved, remove rest of PPE with the second pair of clean gloves.

2. Remove gown. Untie all ties. Some gown ties can be broken rather than untied. Do so in gentle

manner, avoiding a forceful movement. Reach up to the shoulders and carefully pull gown down and away from the body. Rolling the gown down always touching only the inside of the gown. Be careful not to let the gown touch your clothes. Dispose in trash receptacle.

3. Perform hand hygiene.

4. Remove face shield, then goggles or loupes carefully. Remove face shield by grabbing the strap

with two hands and pulling upwards and away from head while leaning forward. Do not touch the front of face shield or goggles or loupes. Wipe face shield with antimicrobial agent in between patients and dispose in trash receptacle at the end of the day. Wash goggles with soap and water and afterwards disinfect with appropriate disinfectant wipes. For loupes, use disinfectant wipes.

5. Remove surgical mask Carefully untie (or unhook from the ears) and pull away from face without touching the front. Dispose in trash receptacle

6. Remove respirator. Do not touch the front of the respirator. If you have a mask over the respirator, remove mask first, then the respirator, remove head cover (bonnet).

a) Respirator: Remove the bottom strap by touching only the strap and bring it carefully over the head while leaning forward. Grasp the top strap and bring it carefully over the head, and then pull the respirator away from the face without touching the front of the respirator. Place respirator in the designated paper bag.

7. Perform hand hygiene, after removing the respirator.

8. Remove the shoe cover. Lift the shoe cover over your heel, pull it off your foot and dispose of in trash receptacle.

9. Perform hand hygiene.

Most dental procedures require the same process described above for donning and doffing of PPE. If, however, the care provider will only be performing routine exam and non-aerosolized procedures, ASTM 2 or 3 surgical face masks could be used in place of N95 masks. The following links provide helpful tip on how to safely don and doff PPE: Donning and Doffing 1 Donning and Doffing 2 Donning and Doffing 3

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Patient Care: Operatory Preparation:

PDM Infection Control & Operatory Preparation

• While wearing gloves and a surgical mask, spray/wipe down surfaces in the entire operatory;

chair, light, computer, cabinets, tubing, etc. with antimicrobial agent.

• Cover overhead light switch/handles and bracket table handle/control unit with the appropriate

barrier tape.

• Cover computer unit, suction, air water syringes and handpiece lines with appropriate barrier

covers.

• Items which are unrelated to patient care MUST NOT be present in the operatory. This includes

student bags, coats and storage boxes (such as gloves, masks and bur boxes)

• Remove gloves.

• Perform hand hygiene: Soap and water or hand sanitizer for a minimum of 20 seconds

• Don appropriate PPE as outlined in protocol

• Patients MUST wear a mask at all times until examination and/or direct intraoral care is

administered.

• Have patient wash hands upon entering for 20 sec with soap and water or with hand sanitizer.

• Intraoral decontamination:

o Patients MUST rinse with 1.5% hydrogen peroxide for one minute.

o All intraoral appliances, such as dentures occlusal splints etc., MUST be disinfected when

adjustment is being performed on them.

• All aerosolized procedures MUST be performed under rubber dam, when possible, and with the

utilization of high-speed evacuation; Mr. Thirsty One Step will be available in all clinics.

• To reduce aerosol; electric hand piece speed MUST be reduced to 100,000 revolutions or below

and the air supply to the hand piece MUST be turned off completely cooling will be done by water

stream only.

• Perform dental treatment.

• At the conclusion of active dental care patients MUST be asked to perform hand hygiene with

hand sanitizer, and they MUST continue to wear their mask, after which time next visit could be

scheduled prior to dismissal (while the patient is still in the chair).

• Patient to proceed to PFS for payment and checkout (if needed). All other patients MUST be

directed to use the Spruce street exit. Patient with disabilities requiring the use of an elevator can

be directed to either the Evans or the Schattner building elevators.

• Dental provider may return instruments, break down the operatory and doff PPE as outlined in

the protocol, but maintain mask and eye protection

• Perform hand hygiene for at least 20 seconds.

• Place clean gloves.

• Remove all plastic barriers and decontaminate all surfaces with antimicrobial agent.

• Purge Suction lines with appropriate solution.

• Purge air water syringe, and hand piece lines (including ultrasonic scalers) for 30 seconds.

• Perform hand hygiene for at least 20 seconds.

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• Patients MUST be asked to inform the dental clinic if they develop symptoms or are diagnosed

with COVID-19 within 48 hours following the dental appointment.

• 48 hours post visit survey with COVID-19 screening questions will be sent automatically to all

patients by Intiveo.

Patient reporting COVID-19 symptoms by phone or by the completion of the Intiveo survey MUST

be contacted by phone.

• Documentation of phone encounters with the patient will be completed in the “Phone Triage”

form under the tabs “Pre-Appoint. Contact” and “Post App Follow Up” tabs respectably.

• Patients answering YES to any of the COVID-19 screening questions will be advised to follow up

with their primary care provider and MUST be reported to the office of Clinical Affairs for the

purpose of tracing.

INFECTION CONTROL DURING EMERGENCY MEDICAL MANAGEMENT:

Providers MUST wear appropriate Personal Protective Equipment (PPE) prior to initiating emergency medical care to patients.

If CPR or bag masking is necessary during the medical emergency, appropriate PPE for aerosol generating procedures (N95, gown, goggles/face shield, head covering, gloves) MUST be worn prior to initiating care.

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Infection Control Supplement Endodontic Clinic:

• The Penn Dental Medicine Infection Control Policy & Protocol applies to the Endodontic Clinic.

In addition, the following guidelines specific to the Endodontic Clinic MUST be followed:

• No personal or any other items unrelated to patient care must be present in any operatory,

waiting area or any area used for donning or doffing PPE. This includes student bags, coats and

storage boxes (such as gloves, masks and bur boxes), with the exception of patient personal items.

All glove boxes must be removed from operatories and placed on cabinet space in the central

aisle. All countertops and surfaces in operatories must be kept clear to allow for disinfection.

• Secure storage of PPE:

• Surgical Suite S1 (upper level).

• Secure storage of PPE such as N95, etc. S1 is lockable and provides cabinet and countertop spaces

for PPE storage. No contaminated PPE to be worn in S1.

• Dispense of PPE:

• In front of surgical Suite S2 (lower level).

• Lockable cabinet space next to CBCT room, daily restock from lockable Surgical Suite S1. Dispense

of N95 masks and face shields follow the general PDM guidelines.

• PPE Requirement:

• https://www.cdc.gov/coronavirus/2019-ncov/hcp/using-ppe.html

• The following PPE is required for treating patients at PDM:

• - Full length disposable gowns

• - Booties/shoe cover

• - Bonnet head cover

• - N95 (or approved substitute) respirator or for all patient encounters

• - Surgical face mask

• - Face shield

• - Gloves

• Donning (putting on the PPE):

• Surgical Suite S2, next to distribution

• Refer to Penn Dental Medicine Infection Control Policy & Protocol for detailed procedure.

• Doffing (removing the PPE):

• Individual bays, we expect all procedures to produce aerosols.

• Additional trash areas will be located near C1 and H rooms.

• Refer to Penn Dental Medicine Infection Control Policy & Protocol for detailed procedure.

• Patient Care:

• Pre-appointment will be handled by the endodontic front desk. Pre-appointment, patients will be

called the day prior to the procedure, answers will be documented in the “Phone Triage” form

under the “Pre-Appont. Contact” tab.

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• Patients MUST be asked to inform the clinic if they develop symptoms or are diagnosed with

COVID-19 within 48 hours following their visit.

• Documentation of phone encounters with the patient will be completed in the “Phone Triage”

form under the tabs “Pre-Appoint. Contact” and “Post App Follow Up” tabs respectably.

• Patients answering YES to any of the COVID-19 screening questions will be advised to follow up

with their primary care provider and MUST be reported to the office of Clinical Affairs for the

purpose of tracing.

• Refer to Penn Dental Medicine Infection Control Policy & Protocol for detailed procedure.

• In addition, dental operating microscopes will require appropriate barrier covers, including

objective lens cap, plastic cover bag and barrier tapes. Plastic cover bag and barrier tapes will be

disposed after the procedure, the microscope specific objective lens caps disinfected with 70%

IPA.

• Rubber-dam use is MANDATORY for all procedures.

• Double high-speed suction provided by a student assisting must be used for all aerosol producing

procedures such as caries or temporary filling removal, access cavity preparation or refinement.

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Infection Control Supplement Orthodontic Clinic: PLEASE NOTE: EVERYONE WILL BE REQUIRED TO FOLLOW ALL POLICY AND PROTOCOL AS OUTLINED IN PENN DENTAL MEDICINE’S INFECTION CONTROL POLICY AND PROTOCOL. THE FOLLOWING IS IN ADDITION TO THIS PROTOCOL: PPE:

• All Faculty, Staff, Residents and Students having direct patient contact or entering an operatory/area with direct patient contact will be required to have PPE as outlined below. Note: A designated area will be identified for donning the appropriate PPE before entering the treatment area.

• Full length disposable gown, shoe cover/bootie, head cover/bonnet, N95 mask or approved

substitute, a surgical facemask to be worn over the N95 mask, face shield, gloves, goggles/eye

protection. We will review the recommended procedures for donning and doffing of PPE prior

to initiating patient treatment.

Patient Care:

• Refer to Penn Dental Medicine Infection Control Policy & Protocol for detailed procedure.

• Patient will be initially triaged and scheduled by orthodontic residents.

• Day before the appointment orthodontic staff will call patients to confirm that they are COVID-19

symptom free, and document in the form “Phone Triage” under the tab “Pre-Appont. Contact”

which includes the COVID-19 screening questions.

• Patients who pass the screening question will be confirmed for their scheduled appointment with

the appropriate resident.

• Patient answering YES to any of the screening questions MUST be canceled and advised to follow

up with their primary care provider.

• Patients will be asked to inform the clinic if they develop symptoms or are diagnosed with COVID-

19 within 48 hours following their visit.

• Patients answering YES to any of the COVID-19 screening questions will be advised to follow up

with their primary care provider, will be documented in the form “Phone Triage” under the tab

‘Post Appt Follow Up” and will be reported to the office of Clinical Affairs for the purpose of

tracing.

• For inventory control and to ensure an adequate supply for everyone, PPE (especially masks) will

be kept in a central location and locked after hours.

• Aerosol generating procedures will only be allowed in the 3 designated rooms that have

enclosures.

• Additional waste receptacles will be provided in designated areas for discarding used PPE. Please

note that the gowns, gloves, outer facemask and hair cover will be discarded. The face shield will

be disinfected for re-use and discarded at the end of the day. The N95 (or equivalent) mask will

be replaced approximately once per week or when soiled/damaged. Proper storing protocol will

be reviewed prior to re-opening.

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Infection Control Supplement Pediatric Clinic:

• The Penn Dental Medicine Infection Control Policy & Protocol applies to the Pediatric Dental

Clinic.

• One resident will be assigned to the Triage. This will be a resident not present in clinic.

• The Day before the appointment patients and accompanying adult will be triaged and screened

by telephone for COVID-19 symptoms by the resident assigned to Triage. This screening will be

documented in the form “Phone Triage” under the tab “Pre-Appont. Contact” which includes the

COVID-19 screening questions.

• Patients or the accompanying adult answering YES to any of the screening questions will be

canceled and advised to follow up with their primary care provider.

• Patients will be asked to inform the clinic if they develop symptoms or are diagnosed with COVID-

19 within 48 hours following their visit, this will be documented in the “Phone Triage” form under

the tab “Post Appt Follow Up”.

• Patients (or the accompanying adult) reporting YES to any of the COVID-19 screening questions

will be advised to follow up with their primary care provider and MUST be reported to the office

of Clinical Affairs for the purpose of tracing.

• All Matrx Scavenger components with the exception of the vacuum shutoff valve and the scavenging control MUST be autoclaved following every use.

1. The nitrous tubing and the scavenging cone MUST be washed with mild alkali detergent and then autoclaved following every use.

2. The breathing bag MUST be also autoclaved following every use.

• For the Silhouette system; masks are disposable 1. The sizer masks (used to size the nose for the nose mask) must be autoclaved after

every use 2. The reusable tubing– MUST be autoclave after each use. a. Breathing bag MUST be autoclaved following each use.

A temperature range of 120oC t- 134o C can be used for the autoclave for both systems Nitrous Oxide units MUST be draped completely with plastic barriers at all times during treatment including when it is not in use. The unit MUST be sprayed/wiped with the appropriate antimicrobial agent after each patient session.

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Infection Control Supplement Periodontics Clinic:

• The Penn Dental Medicine Infection Control Policy & Protocol applies to the Periodontics Clinic.

• Residents will call their patients the morning before the appointment to confirm the appointment

and that they are COVID-19 symptom free. Phone Triage will be documented under the “Pre-

Appoint. Contact” tab of the “Phone Triage” form in axiUm.

• Patients who report COVID-19 symptoms will be advised to see their primary care provider.

Appointment will be cancelled and no attempt to reschedule will be made for at least 14 days.

• Patients will be asked to inform the clinic if they develop symptoms or are diagnosed with COVID-

19 within 48 hours following their visit. This MUST be documented in the “Phone Triage” form

under the tab “Post app Follow Up” in axiUm.

• Patients who report COVID-19 symptoms will be advised to see their primary care provider and

reported to the office of Clinical Affairs by the clinic manager.

• PPE (with the exception of N95 masks and face shields) and gloves will be places on a cart at the

head of each bay.

• All clinical surfaces will be cleared to allow for easy disinfection between patients

• Resident, faculty, and staff MUST house all personal items in their individual lockers.

• A trash can will be placed in each bay (4 bays total), in addition to 1 trash can in the front of the clinic and 1 in the back of clinic.

• The Resident/Faculty Longue will be reserved for CBCT Computer usage and be limited to 1-person max.

• PPE Carts will be locked in the Resident/Faculty Lounge overnight.

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Infection Control Supplement Oral Surgery Clinic: The Oral and Maxillofacial Surgery clinic will adhere to all general policies in place in the Penn Dental Medicine Infection Control Policy & Protocol. General/Patient Flow:

• 2 front desk staff, administrative assistant, and office manager will call 24hr’s in advance of patient visit for triage and screening.

• Facemasks are to be worn at all times by patients, students, faculty, and staff.

• Patient waiting room area will adhere to social distancing guidelines. If the waiting room becomes

full while adhering to these guidelines, patients will be asked to wait in the patient overflow

waiting area and will be notified via phone, text, or in person when they are ready to be seated.

• Upon completion of visit, patient will be scheduled for follow up or next appointments (if

necessary) while seated in chair, rather than at front desk in waiting area to minimize person-to-

person interactions.

• Patients will be asked to inform the clinic if they develop symptoms or are diagnosed with COVID-

19 within 48 hours following their visit. This MUST be documented in the “Phone Triage” form

under the tab “Post app Follow Up” in axiUm. Exposures or potential exposures will be managed

as per CDC recommendations in the “Interim U.S. Guidance for Risk Assessment and Public Health

Management of Healthcare Personnel with Potential Exposure in a Healthcare Setting to Patients

with Coronavirus Disease (COVID-19)” as referenced in the general PDM infection control

protocol.

Procedure:

• Have patient wash hands upon entering for 20 sec with soap and water or with hand sanitizer.

• Have patient rinse with 1.5% hydrogen peroxide or 0.5% povidone iodine solution for 1 minute

and spit back into cup or suction. Do not swallow.

Exams and Non-aerosolizing procedures: o PPE Standard precautions: Gowns, gloves, N95 mask or approved substitute, goggles and face

shield, hair cover. o If during procedure, a surgical drill is necessary and will cause aerosolization, follow aerosol

generating procedure guidelines below. o Utilize High-Volume Evacuation and “4 handed dentistry”. o Utilize resorbable sutures as much as possible. o Have patient wash hands upon exiting operatory. o Prior to leaving room, provider doffs gown and gloves, perform hand hygiene. o After leaving the room, provider doffs eye protection and mask and disposes of

appropriately, then perform hand hygiene. Provider gets a new mask to wear while in clinic and for next patient.

o After patient leaves room, door closed, HEPA filtration unit running. o Individual cleaning the room should wear ASTM level 3 mask, goggles, gloves, and gown if

supplies available. Aerosol generating procedures: o Minimize the number of personnel in the room. Most senior-level and experienced surgeon

should perform the procedure with 1 assistant.

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▪ During intravenous moderate/deep sedations, the required number of ACLS and BLS providers should be in the room with appropriate PPE listed below.

o For Nitrous Oxide follow policy outlined under Pediatric Clinic supplement.

o Keep operatory door closed o PPE: Gown, gloves, N95 mask or approved substitute, goggles, full face shield, hair cover,

shoe covers, surgical mask covers the N95 mask. o Utilize High-Volume Evacuation and “4 handed dentistry”. o Turn on in-room HEPA filtration unit. o Have patient wash hands upon exiting operatory o Upon completion of patient care, prior to leaving room, healthcare provider doffs

gown/gloves and performs hand hygiene. o After leaving the room, N95 respirator stays on, but healthcare provider doffs eye protection

and surgical mask that covers the N95 mask and disposes of appropriately, then performs hand hygiene

o Provider should aim to minimize the number of times they don and doff N95 respirator and consider utilizing N95 mask for the rest of clinic session.

o Clean room with appropriate disinfectant. Individual cleaning the room should wear ASTM level 3 mask, goggles, gloves, and gown if supplies available.

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Infection Control Supplement Oral Medicine Clinics:

• Telehealth: The call center will begin scheduling patients requesting an appointment in the appointment books. The appointment books will be maintained daily with faculty, residents and students (for data collection) and then an appointment will be provided. (See Below)

▪ Providers (faculty or residents, students) will call patients for pre-appointment

screening. Patients will be called the day prior to their visit; answers will be

documented in the “Phone Triage” form under the “Pre-Appont. Contact” tab, based

on which it will be determined if they are to be seen. Additional considerations will be

given to their dental needs and medical risk stratification. Patients who answer Yes to

the screening questions will not be cancelled and asked to follow up with their PCP.

▪ All patients that are suitable to be seen under the current guidelines will be called one day in advance. At this time, we will use this virtual encounter to update medical history, remind patients to have a mask on to enter the building or one will be provided to them, inform them of the questions they will be asked and that there will be temperature checks at the door. Our goal is to have patients check in and go directly to their exam room. The staggering of appointments and careful consideration of maximum numbers of patient appointments should allow minimal patient waiting room density (see below).

▪ 25% of average patient population will be seen initially and we will slowly increase number of patients as we adapt to the new infection control and general workflow. This will be consisting of the following patient cohorts:

• Radiology

• Oral Medicine

• MCC/ICC

• All clinical and non-clinical staff will be trained on the school policy protocol and guidelines required to reduce the risk of exposure to the coronavirus and to keep all staff, faculty, students and patients safe before opening.

• Front Desk Check in protocol ▪ Two assistants at check in will be sitting over 6 feet apart. Our third assistant with

proper PPE, will be greeting patients at the door and confirming they are in the correct location and maintaining order. They will have steady communication with the clinic director and faculty in the exam rooms.

▪ Check out and follow-up visit (FUV) will be completed in the exam rooms to prevent front desk patient density.

▪ Patients will be directed to exit through the back door to limit patients at check in area.

• General Principles ▪ At no point will there be more than 8 patients at any given time ▪ MCC has 6 chairs/3 in use at a time/ 3 to clean and use if overflow is needed and to

maintain separation ▪ Radiology has 4 chairs and 1 overflow ▪ OM has 1 chair and 1 overflow

• Radiology

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▪ All CBCT scans MUST require an appointment, internally the students will fill out a rad con/ referral form and through Axium they will request an appointment. This will be received by the front desk and scheduled as soon as possible including same day and near immediate.

▪ Dr. Mel and Dr. Dayo will be responsible for taking all CBCT’s and immediately completing the report. A rotation schedule has been implemented among the faculty.

▪ The Radiology technicians will have a rotation list----1 person will be responsible for taking panoramic radiographs, while the other 2 will be responsible for taking intraoral radiographs with assistance from novice 3rd year students and they will stay in their designated rooms.

▪ The radiology tech who is assigned to taking panoramic radiographs is also required to maintain all 5 rooms for radiology. This includes preparing and cleaning and setup of these rooms.

▪ The MIPACS controlled capture will be utilized and faculty will make a determination as to what radiographic are needed for the patient. The radiographs are ordered within axiUm and the request sent to MIPACS electronically.

▪ Selection criteria will be used to select and obtain radiographs based on ADA guidelines, a properly obtained PAN and 4 BWs would be equivalent to an FMX in some cases.

▪ All radiology procedures are performed using standard PPE equipment. ▪ All radiology consults (from the clinical departments and post graduate consults) are

to be done virtually sharing the screens. Approvals for an appropriate consult time will be done remotely.

▪ All departments MUST call the front desk to request a Pan or submit a request through axiUm, all patients MUST be scheduled, NO walk-in patient can be allowed.

• Oral Medicine ▪ Oral Medicine will have a telehealth book and follow the same procedures for

appointing in person visits. ▪ Patients of record that need to see an Oral Medicine specialist must be referred

using the axiUm referral system. The front desk will print all referrals and have them reviewed by faculty before scheduling.

▪ All patients that are suitable to be seen under the current guidelines will be called one day in advance for a virtual encounter to update medical history, remind patients to have a mask on to enter the building or one will be provided to them, inform them of the questions they will be asked and that there will be temperature checks at the door. The goal is to have patients checked in and go directly to their examination/treatment rooms.

• MCC/ICC ▪ MCC/ICC will use 6 rooms. ▪ All patients that are suitable to be seen under the current guidelines will be called

one day in advance for a virtual encounter to update medical history, remind patients to have a mask on to enter the building or one will be provided to them, inform them of the questions they will be asked and that there will be temperature checks at the door. The goal is to have patients checked in and go directly to their examination/treatment rooms.

▪ There will be a schedule posted among faculty to conduct this telehealth appointment.

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▪ High velocity suction, rubber dam, electric handpieces with adjusted speed and air supply, and when possible, hand instruments will be used for dental procedures to reduce the spread of aerosol.

▪ Patients will be asked to inform the clinic if they develop symptoms or are diagnosed with COVID-19 within 48 hours following their visit. This MUST be documented in the “Phone Triage” form under the tab “Post app Follow Up” in axiUm. Patients answering YES to any of the COVID-19 screening questions will be advised to follow up with their primary care provider and MUST be reported to the office of Clinical Affairs for the purpose of tracing.

• PPE Guidance ▪ The Penn Dental Medicine Infection Control Policy & Protocol applies to the Oral

Medicine Clinics.

▪ Donning of PPE MUST be done in separate clean area away from patient rooms (assigned areas in Oral medicine Dispensing area- limit number of people donning to 2 at every time point).

▪ Doffing of PPE will be done at the exit door of each patient care room. Receptacles will be provided for disposal of contaminated PPE close to the exit door of each room.

• Exam Rooms/Dental chairs ▪ The Penn Dental Medicine Infection Control Policy & Protocol applies to the Oral

Medicine Clinics.

▪ All computer screens keyboards and mouse will be covered with plastic barriers and changed after each patient.

▪ X-ray units will be covered when not in use. ▪ No items, which are not related to patient care and cannot be disinfected, to be on

the countertop in treatment rooms.

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Infection Control Supplement Comprehensive Care Clinics: Scheduling and Check-in

• Coordinators and call center will be scheduling patients requesting an appointment in the student appointment books. The appointment books will be maintained daily with faculty and students (for data collection).

• Students will call patients to determine if they are to be seen based on their dental needs and medical risk stratification. All patients that are suitable to be seen under the current guidelines will be called one day in advance of their scheduled appointment. At this time, the treating student will use the virtual encounter to update medical history, remind patients to have a mask on to enter the building or one will be provided to them, inform them of the questions they will be asked and that there will be temperature checks at the door. Patient screening MUST be documented in the form “Phone Triage” under the tab “Pre-Appont. Contact” which includes the COVID-19 screening questions.

• Patient answering YES to any of the screening question, their appointment MUST be canceled and should be advised to follow up with their primary care physician and to follow their recommendations.

• Upon arrival to PDM patients who pass the screening will be checked in and instructed to go directly to the operatory of the treating student. The staggering of appointments and careful consideration of maximum numbers of patient appointments should allow minimal to no patient waiting room density. Approximately 10% of average patient population will be seen initially and this will decrease through June until the rising and new clinical students return to start the new semester.

• Patients will be asked to inform the clinic if they develop symptoms or are diagnosed with COVID-19 within 48 hours following their visit. This MUST be documented in the “Phone Triage” form under the tab “Post app Follow Up” in axiUm. Patients answering YES to any of the COVID-19 screening questions will be advised to follow up with their primary care provider and MUST be reported to the office of Clinical Affairs for the purpose of tracing.

• All clinical and non-clinical staff will be trained on and required to abide by the infection control school policy/protocol and guidelines required to reduce the risk of exposure to COVID 19 and to keep all staff, faculty, students and patients safe before opening and during patient care.

• Check in protocol - Patients will check in at the designated PDM entry and students will immediately bring the patients to their operatories avoiding the waiting area whenever possible. Check out and the scheduling of follow-up visit (FUV) will be completed in the operatories whenever possible to prevent crowding in the areas of patient coordinators and the office of PFS. Patients will be directed to exit through the designated PDM patient exit doors.

General Principles

• All aerosol generating procedures will be handled per the guidance of this document listed above. N95 respirators or their comparable will be worn during all dental procedures that generate aerosol. Faculty will stay engaged with clinical monitors such as to reduce the number of person to person interactions in the clinical passageways between the operatories when students are ready for evaluation. Special equipment such as Cerec carts must be completely covered with disposable plastic draping or wrap such that no surface contamination is possible. All computers and peripheral devices will be fully covered. These protections are to be changed after each patient.

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Further reduction of aerosol spread should be controlled through the use of high velocity suction, rubber dam, disposable “Mr. Thirsty” suction/retraction devices, electric handpieces with adjusted speed and air supply, and when possible, hand instruments will be used for dental procedures to reduce the spread of aerosol.

PPE Guidance

• The Penn Dental Medicine Infection Control Policy & Protocol applies to all Comprehensive Care Clinics. Donning of PPE must be done in separate clean area away from patients in operatories (assigned areas in Schattner Dispensing area near lockers) and are limited to two people donning at every time point. In Shils Clinic Donning of PPE is to be done southwest of the dispensing window near the crash cart and is also limited to two people at a time. Doffing of PPE will be done in the individual operatory and is to be done per prior instructions. Receptacles will be provided for disposal of contaminated PPE in existing and additional areas of the clinics. Any items unrelated to patient care may not be on the counters or tops of the 12 o’clock cabinets in treatment rooms. Personal clothing (other than that of the patients) is not permitted in the operatories.

Standard Precautions

• New COVID-19 PPE guidelines are not a substitute for the observation of Standard Precaution protocols. Hand washing, workplace and engineering controls, eye protection with side shields and BFE post exposure protocols are still maintained and followed as per prior instruction.

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Infection Control Supplement Prosthodontic Clinic:

The Penn Dental Medicine Infection Control Policy & Protocol applies to the Prosthodontic Clinic.

PLEASE NOTE: EVERYONE WILL BE REQUIRED TO FOLLOW THE POLICY AND PROTOCOL AS OUTLINED IN PENN DENTAL MEDICINE’S INFECTION CONTROL POLICY AND PROTOCOL. THE FOLLOWING IS IN ADDITION TO THIS PROTOCOL:

Patient Scheduling

• Patients will be contacted 24 hours prior to their visit at which time the resident and/or coordinator will triage the patient by asking the required screening questions.

• This will be documented in the form “Phone Triage” under the tab “Pre-Appont. Contact” which includes the COVID-19 screening questions

• Patients who pass the screening question will be confirmed for their scheduled appointment with the appropriate provider.

• Patient answering YES to any of the screening questions MUST be canceled and advised to follow up with their primary care provider

• Up to five residents will schedule patients per day. Only patients in the middle of treatment will be scheduled (in temporary crowns or other emergencies). Goals: Deliver what is already back from the lab, make impressions if teeth prepped and approved, or just recement temps. No new treatment will start in Stage I, except for emergency.

• With 5 residents each with a patient / session it is feasible: o to maintain distance inside the clinic and outside in the waiting area, o that the pm residents/patients will use different chairs/operatories from the morning

ones so that each operatory is not used again for another 24 hours, o Only residents and faculty that have patients scheduled for that half day will be present

in the clinic.

• Patients will be asked to inform the clinic if they develop symptoms or are diagnosed with COVID-19 within 2 days following their visit. This MUST be documented in the “Phone Triage” form under the tab “Post app Follow Up” in axiUm. Patients answering YES to any of the COVID-19 screening questions will be advised to follow up with their primary care provider and MUST be reported to the office of Clinical Affairs for the purpose of tracing.

• Resident, faculty, and staff MUST house all personal items in their individual lockers.

• All clinical surfaces will be cleared to allow for easy disinfection between patients.

• Facemasks are to be worn at all times by patients, students, faculty, and staff.

• Patient waiting room area will adhere to social distancing guidelines. Only up to five patients will be allowed in the waiting room who will be there by appointment only.

• Appointments must be confirmed 24 hours prior at which time the resident will triage the patient by asking the required screening questions and completing “Pre-Appont. Contact” tab of the Phone Triage form.

• Up to five residents will schedule patients per day. During the first stage of opening only patients in the middle of treatment will be scheduled (in temporary crowns or other emergencies). Goals: Deliver what is already back from the lab, make impressions if teeth prepped and approved, or just recement temps. No new treatment will start in Stage I, except for emergency.

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• With 5 residents each with a patient / session it is feasible: o To maintain distance inside the clinic and outside in the waiting area, o Only residents and faculty that have patients scheduled for that half day will be present

in the clinic.

• For inventory control and to ensure an adequate supply for everyone, PPE (especially masks) will be kept in the dispensary room (a central location and locked after hours).

• PPE (with the exception of N95 masks and face shields) will be placed outside each operatory at the beginning of each bay by the dental assistant.

• Each resident will wash hands upon entering for 20 sec with soap and water and then start donning (putting on the PPE) outside the operatories as specified at the Penn Dental Medicine Infection Control Policy & Protocol.

• Ask patient to wash hands upon entering for 20 sec with soap and water or with hand sanitizer.

• Have patient rinse with 1.5% hydrogen peroxide or 0.5% povidone iodine solution for 1 minute

and spit back into cup or suction. Do not swallow.

Aerosol generating procedures:

• Only electric handpieces will be allowed at <100,000 rpm and without air, use only water for cooling to reduce aerosol.

• Isovac or equivalent must be used in addition to high velocity suction next to the tooth.

• After treatment is completed, every surface must be disinfected following the Penn Dental Medicine Infection Control Policy & Protocol

• The doffing (removing the PPE) will be done after the operatory disinfection and disposed in each individual operatory trash can (except from N95 and face shield) as specified at Penn Dental Medicine Infection Control Policy & Protocol. Face shield must be disinfected and then perform hand hygiene for at least 20 seconds again.

• Patients MUST be asked to inform the clinic if they develop symptoms or are diagnosed with

COVID-19 within 48 hours following their visit.

• Plan to call patients 2-4 days postop to inquire about postop course as well as COVID-19

symptoms. Exposures of potential exposures will be managed as per CDC recommendations in

the “Interim U.S. Guidance for Risk Assessment and Public Health Management of Healthcare

Personnel with Potential Exposure in a Healthcare Setting to Patients with Coronavirus Disease

(COVID-19)” as referenced in the general PDM infection control protocol.

Special Prosthodontic Equipment:

• The dental microscopes will not be used during Stage I opening. It must be covered with plastic barriers during aerosol generating patient care and removed after every patient.

• Usage of intraoral scanner must include the updated required and recommended draping from the manufacturer as identified in the Restorative Department.

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Prosthodontic Laboratory:

• Up to two people will be in the Prosthodontic Lab at any time. No lab work will be required from

the residents during Stage I except for lab procedures required to support chairside treatment

(pour alginate, polish interims, dentures). Most laboratory procedures should be done in the

clinic, chairside, and faculty approval will be required to leave the clinic and enter the lab.

Prosthodontic Studio:

• This door will remain closed and it will be used as a clean room to store PPE and donning (putting

on the) of PPE. No residents, faculty or staff can enter the room in the middle of treatment while

wearing PPE that might be infected.

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Infection Control Supplement Penn Dental Family Practices: PDFP will adhere to all general policies in place in the Penn Dental Medicine Infection Control Policy & Protocol.

General/Patient Flow:

• Facemasks are to be worn at all times by patients, students, faculty, and staff.

• Patient waiting room area will adhere to social distancing guidelines. If the waiting room becomes

full while adhering to these guidelines, patients will be asked to wait in the patient overflow

waiting area at Locust Walk and in the South lobby of 3737 Market location and will be notified

via phone, text, or in person when they are ready to be seated.

• Upon completion of visit, patient will be scheduled for follow up or next appointments (if

necessary) while seated in chair, rather than at front desk in waiting area to minimize person-to-

person interactions.

• All patients will be pre-screened for COVID 19 questions 1 business day prior to appointment date

(see page 3).

• Patients will be asked to inform the clinic if they develop symptoms or are diagnosed with COVID-

19 within 2 days following their visit. This MUST be documented in the “Phone Triage” form under

the tab “Post app Follow Up” in axiUm. Patients answering YES to any of the COVID-19 screening

questions will be advised to follow up with their primary care provider and MUST be reported to

the office of Clinical Affairs for the purpose of tracing.

• All magazines, and brochures will be removed from reception areas.

• All counters at reception will be free of items and will be sanitized after each patient encounter.

• Staff will follow social distancing guidelines in all common areas such as restrooms, breakrooms

and personal offices.

Procedure:

• Have patient wash hands upon entering for 20 sec with soap and

water or with hand sanitizer.

• Have patient rinse with 1.5% hydrogen peroxide or 0.5% povidone

iodine solution for 1 minute and spit back into cup or suction. Do not

swallow. Exams and Non-aerosolizing procedures: o PPE Standard precautions: Gowns, gloves, N95 mask or approved

substitute, goggles and/or face shield, hair cover

o If during procedure, a handpiece is necessary and will cause aerosolization, follow aerosol generating procedure guidelines below.

o Have patient wash hands upon exiting operatory. o Prior to leaving room, provider/DA team doffs gown and gloves, perform hand hygiene. o After leaving the room, provider/DA team doffs and disinfects face

shields and eye protection then perform hand hygiene.

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o Individual cleaning the room must wear ASTM level 3 mask, goggles, gloves, and gown if supplies available.

Aerosol generating procedures:

• Minimize the number of personnel in the operatory. Only provider,

one DA and patient should be present.

• Utilize High-Volume Evacuation and “4 handed dentistry”.

• Utilize isolation devices such as Isovac, Mr. Thirsty or rubber dam

systems.

• Reduce Electric handpiece speed to a maximum of 100,000 revolution

and turn off the air supply completely. This will significantly reduce the

aerosolization.

Nitrous Oxide protocol:

• All Matrix Scavenger components with the exception of the vacuum

shutoff valve and the scavenging control MUST be autoclaved

following every use.

• The nitrous tubing and the scavenging cone MUST be washed with

mild alkali detergent and then autoclaved following every use. The

breathing bag MUST be also autoclaved following every use.

• For the Silhouette system; masks are disposable

• The sizer masks (used to size the nose for the nose mask) MUST be

autoclaved after every use.

• The reusable tubing– MUST be autoclave after each use.

• A temperature range of 120oC t- 134o C can be used for the autoclave

for both systems

• Nitrous Oxide units must be draped completely with plastic barriers at

all times during treatment, the unit must be sprayed/wiped with the

appropriate antimicrobial agent after each patient session.

Microscope Protocol:

Microscopes will require appropriate barrier covers, including objective lens cap, plastic cover bag and barrier tapes. Plastic cover bag and barrier tapes will be disposed after the procedure, the microscope specific objective lens caps disinfected with 70% IPA.

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Appendix

Respiratory Protection

Air-Purifying Respirator Policy

Purpose: In furtherance of safe-work practices and respiratory protection, outlined in the Infection Control Policy and Protocol and required by OSHA, this policy serves to reduce the risk of exposure to contagious agents that are spread by droplet contact, such as the

coronavirus SARS-CoV-2 and expanding the use of air- purifying respirators to include Power Air-Purifying Respirator (PAPR), Elastomeric Full-Facepiece Respirators, and Elastomeric Half -Facepiece Respirators for patient encounters and instances involving

gases, vapors, particles, and the management of designated aerosol producing procedures. Scope: This protocol applies to all faculty, staff, students, residents and patients, of Penn Dental Medicine (PDM).

PDM will continue to monitor recommended updates by official bodies such as the CDC, OSHA, and ADA and update our protocols accordingly.

Goal: The goal of Respirators is to mitigate risks and protect our faculty, staff, students, and patients of PDM during patient encounters and instances involving the management of

aerosol producing procedures. Policy: A respirator must be provided to dental providers when such equipment is necessary to protect the health of faculty, staff, students, residents and patients of PDM during the

management of aerosol producing procedures. Requirements and information for respiratory protection, including in a dental care setting, can be

found on OSHA websites.

Definitions:

Filtering Facepiece Respirator (FFR) also known as “N95 masks” is a negative pressure particulate respirator with a filter as an integral part of the facepiece or with the entire

facepiece composed of the filtering medium.

Properties of FFR are:

• Disposable

• Covers the nose and mouth

• Filters out particles such as dust, mist and fumes

• Selections range from N, R, P series and 95, 99, 100 efficiency level

• Does not provide protection against gases and vapors

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• Fit testing required

For information on proper Donning and Doffing of Personal Protective Equipment, including for FFR and fitting, please refer to the COVID 19 Infection Control Protocol and Policy.

Powered Air-Purifying Respirator (PAPR) means an air-purifying respirator that uses a

blower to force the ambient air through air-purifying elements to the inlet covering. PAPRs reduce the aerosol concentration inhaled by the wearer to at least 1/25th of that in the air,

compared to a 1/10th reduction for FFRs and elastomeric half facepiece air-purifying respirators. OSHA assigns an APF of 1,000 to some PAPRs with hoods or helmets.

Properties of PAPR’s include:

• Reusable components and replaceable filtrs or cartriges

• Can’t be used to protect agains gases, vapors or particles if equipped with the appropriate

cartridge, canister or filter

• Battery powered with blower that pulls air through attached filters or cartrges

• Provides eye protection

• Low breathing resistance

• Loose-fitting PAPR does NOT require fit testing and can be used with facial hair

• Tight-fitting PAPR requires fit testing

When used properly, PAPRs provide increased protection and decrease the likelihood of infection

transmission to the wearer as compared to FFRs and half face reusable elastomeric respirators.

During extended procedures in which aerosols or other splashes/sprays of water, saliva, or

other body fluids could cause moisture to collect in/on a filtering facepiece respirator, OSHA recommends using an R95, P95, or better filtering facepiece; elastomeric respirator

with an appropriate cartridge; or powered air-purifying respirator (PAPR). FOR PATIENT PROTECTION AND PROTECTION OF OTHERS, PROVIDERS MUST WEAR AN ASTM 3 MASK WHILE OPERATING WITH THE PAPR ON

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PAPR: The following CDC links provide helpful tips on how to safely Donning and Doffing PAPR:

Donning PAPR

Doffing PAPR

Donning PAPR: Step by Step

Doffing PAPR: Step by Step

Cleaning and Disinfection of PAPR Components:

Filter/Cartridge Cleaning and Disinfection: PAPR components must be cleaned, disinfected, and if not damaged, can be reused many times. For additional information on proper cleaning and disinfecting PAPR, click here. Elastomeric Full-Facepiece and Elastomeric Half-Facepiece Respirators: Elastomeric respirators,

such as half facepiece or full facepiece tight-fitting respirators where the facepieces are made of

synthetic or natural rubber material, can be repeatedly used, cleaned, disinfected, stored, and re-

used.

Properties of Elastomeric Full-Facepiece Respirator include:

• Reusable facepiece and replaceable canisters, cartridges or filters

• Can be used to protect against gases, vapors or particles if equipped with the appropriate

cartridge, canister or filter

• Provides eye protection

• More effective face seal than FFR’s or elastomeric half-facepiece respirators

• Fit testing required

Properties of Elastomeric Half-Facepiece Respirators:

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• Reusable facepiece and replaceable canisters, cartridges or filters

• Can be used to protect against gases, vapors or particles if equipped with the appropriate

cartridge, canister or filter

• Covers the nose and mouth

• Fit test required FOR PATIENT PROTECTION AND THE PROTECTION OF OTHERS, AN ASTM 3

SURGICAL MASK MUST BE USED TO COVER THE EXHALATION VALVE.

Step-by-step information on proper Donning and Doffing Elastomeric Full-Facepiece Respirators can be found here.

Cleaning and Disinfection of Elastomeric Respirator:

Use disinfectant wipes, or wipes saturated with 200 ppm Hypochlorous acid (Pure&Clean) to clean

the respirator inside and out but you MUST avoid getting the filter material wet. You may also wash the respirator in soapy water after the removal of the filter cartridges. The inside of the mask has two inhalation valves (1 behind each cartridge) and one exhalation valve (center of mask). The inhalation valves need to be flat and flush with the mask to work

appropriately. THESE VALVES MUST BE INSPECTED PERIODICALLY TOO. The P100 cartridges should be replaced annually, they should also be replaced when they become harder to breathe through or if when they become wet or contaminated.

In addition to information on cleaning, disinfection and the use of Elastomeric Respirators can be

found on the CDC website.

Contact the Office of Clinical Affairs for additional information on scheduled fittings for Air-

Purifying Respirators: Room 245 Evans Building, (215) 898-8975.