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Managing the Coronavirus in a Dental Lab or Dental Practice Setting

Coronovirus

The current outbreak of the 2019 Novel Coronavirus (2019-nCoV) has generated a lot of questions from our clients on what they should be doing in their dental laboratory or dental practice. The simple answer is, keep doing what you have been doing. That means following Standard Precautions and disinfecting everything that has been in contact with a dental patient’s body fluids. More procedures may need to be followed depending on the circumstance. Read on to learn more.


Because this particular strain of Coronavirus is new, the Centers for Disease Control (CDC) is still learning about the epidemiology of the virus, including modes of transmission and length of time the virus is viable outside of the body. This information is consistently being updated by the CDC.

As of January 31st the CDC stated that the incubation period for this virus is any where from 5 days to 14 days. Focus is on individuals who have been in mainland China and have traveled to other countries. People most susceptible to the virus are: elderly, immuno-compromised, other medical issues such as lung disease and other types of cancer, liver disease, kidney disease, people with pneumonia. Any contact with an infected person can transmit the virus to someone else if that individual is within 6 feet of the infected person for 10 minutes or more. CDC stated that they do not have evidence that asymptomatic people are spreading this virus, but it is an active area of investigation. The CDC also stated that currently it should be treated as viral pneumonia. They did not comment on any drugs that should be used for treatment.

Patients Under Investigation (PUI) have shown the following symptoms:

  • Fever
  • Lower respiratory condition
  • Coughing
  • Shortness of breath

Not all infected persons have fever at onset but may have fatigue, diarrhea, headache, sore throat.

Healthcare Workers - Employee Protection
For healthcare workers the CDC recommends use of the N95 respirator as a face mask. Also protect your eyes, wear gloves, and gown.  CDC recommends only use of disposable gowns rather than washing them.  Washing your hands is critical to practicing standard precautions. Practicing Universal or Standard Precautions includes:

  • frequent hand washing,
  • decontamination of critical, semi-critical, and non-critical items and surfaces,
  • wearing of eye protection, mask, gloves, and gown, and
  • sharps safety.

Learn more from OSHA about 2019 Novel Coronavirus

Learn more from CDC

We have experienced these kinds of situations before with outbreaks of other types of viruses, including SARS, MERS, Avian Flu, Swine Flu, and Ebola. With all of these outbreaks the risk of transmission from dental patient to dental lab has been miniscule at this point. 3 Steps to Warding Off the Flu 

Dental Lab NOT outsourcing to China
If you are a dental lab that does not outsource to China, then the likelihood of receiving an item contaminated with the virus is pretty minute at this time.

For the virus to get to a dental laboratory:

  • There has to be an infected person being treated in a dental practice
  • That infected person has to have a need for a dental laboratory service
  • Patient contact items have to be sent to a dental lab
  • Infected patient comes into lab for shade verification
  • Dental Lab technician provides dental practice chair-side services to an infected patient

Dental Lab OUTSOURCING to China
If the lab is outsourcing to China, then the best procedure would be to ensure that all items sent from China are disinfected with a product that is virucidal. Labeling indicating that it has been disinfected should be in place if the package is sent directly to the dental client without opening or repackaging.

The importing lab could open and disinfect the items. Employees should observe the proper infection control protocols, including wearing all Personal Protective Equipment, mask, gloves, protective eyewear, and protective garment.

If the lab has employees working in China, then it is important that they protect themselves from exposure situations and observe any travel bans that might be in place. They should seek treatment immediately if they exhibit symptoms of a respiratory infection.

General Dental Practice
There is no directive that we’re aware of at this time from the CDC specific to dental practices, however, if your dental practice is in an area that has reported patients with the virus, or you have other reasons to take added precautions, you can consider the following guidelines.

The general dental practice should be doing a thorough medical screening for each patient. If the patient is exhibiting any of the symptoms of a respiratory infection, then the dentist should ask if the patient has been in China recently. The dentist should defer treatment until the patient has been examined by a medical professional. Notify your Public Health Department for guidance.  

Recommendations for Managing the Risks of the Coronavirus in General Dental Practice
These recommendations have been prepared using information gathered from the CDC and other recognized agencies.

Employee Protection

Practice Universal or Standard Precautions.  This includes:

  • frequent hand washing,
  • decontamination of critical, semi-critical, and non-critical items and surfaces,
  • wearing of eye protection, mask, gloves, and gown, and
  • sharps safety.

Employees who meet any of the Clinical features and Epidemiologic Risks below should notify their employer and consult with their personal physician regarding treatment.

Clinical features and Epidemiologic Risks:

Clinical Features

&

Epidemiologic Risk

Fever or signs/symptoms of lower respiratory illness (e.g. cough or shortness of breath)

AND

Any person, including health care workers, who has had close contact with a laboratory-confirmed 2019-nCoV patient within 14 days of symptom onset

Fever and signs/symptoms of a lower respiratory illness (e.g. cough or shortness of breath)

AND

A history of travel from Hubei Province, China within 14 days of symptom onset

Fever and signs/symptoms of a lower respiratory illness (e.g. cough or shortness of breath) requiring hospitalization

AND

A history of travel from mainland China within 14 days of symptom onset

Close contact is defined as:

  • being within approximately 6 feet (2 meters), or within the room or care area, of a 2019-nCoV case for a prolonged period of time while not wearing recommended personal protective equipment or PPE (e.g. gowns, gloves, NIOSH-certified disposable N95 respirator, eye protection); close contact can include caring for, living with, visiting, or sharing a health care waiting area or room with a 2019-nCoV case -or-
  • having direct contact with infectious secretions of a 2019-nCoV case (e.g. being coughed on) while not wearing recommended personal protective equipment.

Patients who call in to make an appointment should be asked if they meet any of the Clinical Features and Epidemiologic Risks above by asking the following questions: 

Do you have:

1) Fever or history of fever AND acute respiratory infection (shortness of breath or cough or sore throat) or severe acute respiratory infection without fever requiring hospitalization; and

2) Epidemiological criteria - a history of being in Wuhan, China in the 14 days prior to symptom onset or;

3) Close contact within 14 days of symptom onset with any of the following:
•    a confirmed or suspected case of 2019-nCoV;
•    a healthcare facility in China.

If so then recommend that the patient delay making any non-urgent dental appointments.  If they need emergency dental care, then refer them to the Public Health Department.  Have that phone number available to provide to them. Notify your Public Health Department for guidance.

It might also be wise to display a sign in the waiting room of the practice for those patients who walk in to make an appointment. The contents of the sign could inform them that if they have traveled to China within the past 14 days or have fever, cough, or trouble breathing, they should first put on a mask and then inform you. If they have these symptoms, then it’s best to defer their treatment.

Daily decontamination of waiting room furniture and furnishings is advisable.

Disclaimer:  This is not legal advice.  Prior to implementing any policies regarding the above steps for employee and/or patient protection, you should seek legal advice from your attorneys on any employment and labor law issues that will be raised by concerns about 2019-nCoV.

Contact SafeLink Consulting to get help with patient safety.

Infection Prevention Coordinator's Responsibilities for the Dental Practice

If you have any questions or need assistance, please contact SafeLink Consulting or visit our website to learn more about how we can help your business. 

WATCH INTRO VIDEO - Bloodborne Pathogens: Re-examining Your Exposure Controls (including Infection Control) for the Dental Environment:

 

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