The pandemic of the Coronavirus Disease 2019 (COVID-19) has created real challenges and uncertainties for businesses around the world. Needless to say, all of us at SafeLink Consulting have been responding to questions from our clients on what they should be doing in their dental laboratory to protect themselves and their clients. At a minimum the dental laboratory should be following guidance from their state regulating bodies and the Centers for Disease Control and Prevention (CDC). 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. The following recommendations have been prepared using information gathered from the CDC, OSHA, and other recognized agencies. CDC Recommendations: Postpone Non-Urgent Dental Procedures, Surgeries, and Visits
This info is constantly being updated as new information is available so be sure to check back often for new content.
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 the dental lab has been minimal at this point; however, Standard Precautions should always be followed.
Disinfectants Effective Against COVID-19
For COMMERCIAL/HOSPITAL-LEVEL DISINFECTANTS: SafeLink has consulted with manufacturers of some of the most commonly used products in dental practices and dental labs for disinfecting. What we learned was that not all disinfectants are effective in inactivating the COVID-19 virus. We are not recommending any particular disinfectants to use since there are so many out there. It is best to contact the manufacturer of that product to confirm whether or not it is effective against COVID-19. Follow the manufacturer’s instructions for use for your particular application.
For HOUSEHOLD DISINFECTANTS: EPA has published a list of common household disinfectants that can be used on potentially contaminated surfaces. This list is referenced above and may not include all disinfectants (continually updated). Use this EPA list to reference any common HOUSEHOLD disinfectant products you may be using in your office or home. Disinfectants must meet the criteria published by the EPA in the document titled, "GUIDANCE TO REGISTRANTS: PROCESS FOR MAKING CLAIMS AGAINST EMERGING VIRAL PATHOGENS NOT ON EPA-REGISTERED DISINFECTANT LABELS", to claim effectiveness against this new virus.
Dental Lab Manufacturing In-House Only and NOT outsourcing to a Foreign Dental Lab
The dental practices that are open at this time have been instructed by their State authorities to only provide treatment that is essential or an emergency. That means that there is still the need for dentures, denture repairs and even crowns. So let's look at the risks to the dental laboratory.
For the virus to get to a dental laboratory:
- There has to be an infected person who is being treated in a dental practice and dentists should be screening patients prior to treatment;
- That infected person has to have a need for a dental laboratory service and currently must be considered essential or an emergency;
- Patient contact items have to be sent to a dental lab;
- Infected patient comes into lab for shade verification; and/or
- Dental Lab technician provides dental practice chairside services to an infected patient.
The last two situations would provide direct patient contact, therefore, they would place the dental lab employees performing these services at greatest risk. If you are providing shade verification services at your dental lab for your dental clients, then you should confirm with your dental clients that they are screening their patients for risks of exposure to COVID-19 before they send them to you. It may even be best to discontinue this service until this pandemic has passed. Learn more about the Epidemiologic Risks that the Centers for Disease Control have provided for screening purposes.
Here's a poster to help you take a proactive approach to asking visitors to your lab about their COVID-19 virus exposure. This would be appropriate to post on or near your facility's entrance and/or front reception. If you plan to use this poster, then designate a representative in your lab for visitors to call so that person can discuss their purpose and approve their admission to your facility. Get Coronavirus Poster for the Dental Lab
If you are providing your dental clients chairside services of any kind, then it is your responsibility to train your employees who will provide these services how to protect themselves. You can review the infection control protocol that SafeLink Consulting developed. Confer with your dental clients to ensure that your employees will not be requested to provide any chairside services for patients they know have answered yes to any of the COVID-19 screening questions.
Learn more about Virtual Safety Assessment for the Dental Laboratory.
Dental Lab OUTSOURCING
If the lab is outsourcing to another country, then the best procedure would be to ensure that all items sent from the foreign lab are disinfected with a product that is virucidal prior to shipment to you. Labeling indicating that it has been disinfected should be in place by the foreign lab if the package is shipped by the foreign lab directly to the dental client without opening or repackaging. There's information now regarding the length of time this virus can live outside the body and on certain surfaces.
Dental devices received from the foreign lab to the importing lab could be opened and disinfected. Employees at the importing dental lab should observe the proper infection control protocols, including wearing all Personal Protective Equipment that includes mask, gloves, protective eyewear, and protective garment.
If the lab has employees working outside the U.S., 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.
Dental Lab Employee Safety & Protection
OSHA directs your business to first use engineering controls, then work practice and administrative controls prior to the use of personal protective equipment (PPE). Review this information on the OSHA website for healthcare workers to determine if any of those controls are possible in your dental lab that will provide protection when PPE is not available. Review CDC's How to Protect Yourself and How Coronavirus Spreads publications with your employees. Dealing with this pandemic at work and at home is very stressful for all of us. CDC has some guidelines for Stress and Coping that may be helpful to you.
For healthcare workers who are treating patients infected with COVID-19, the CDC recommends use of the N95 respirator. 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 PPE - eye protection, mask, gloves, and gown, and
- sharps safety.
We know that it is difficult to obtain disposable face masks, hand sanitizer, gloves and disinfectants right now so look for alternatives as well as engineering controls and administrative controls. Also, if you begin requiring an N95 respirator, then your health and safety program must include a Respiratory Protection Program. If your business is using SafeLink's Cloud-based health and safety manual then you already have that program. When respiratory protection is mandatory, you’ll need to perform fit testing and have medical questionnaires completed for employees who are required to wear them. That medical questionnaire must be submitted to a healthcare professional for review to determine if it is ok for the employee to wear a respirator. OSHA has issued a Temporary Enforcement Guidance - Healthcare Respiratory Protection Annual Fit-Testing for N95 Filtering Face pieces during the COVID-19 Outbreak. This Memorandum states that annual fit-testing of the respirator is not required under the current circumstances, however, initial fit-testing is required. If you were already requiring respirators for protection from silica, for instance, then you should continue your fit-testing as you've being doing. Contact us for further guidance on these requirements.
Employees who meet any of the Clinical features and Epidemiologic Risks should notify their employer and consult with their personal physician regarding treatment.
If you plan to do training of your employees, it is recommended that you use OSHA’s information published on protection of workers from the coronavirus along with information from the Centers for Disease Control. Stress to your workers the need to continue to practice Standard Precautions. Learn more about Virtual Safety Training for the Dental Laboratory.
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 regarding symptoms to watch for is available on the CDC website.
The initial concern was with people who had traveled to other countries, however, now there is concern regarding travel between states and especially in those states where COVID-19 is more prevalent. The people most susceptible to the virus still seem to be the elderly, immuno-compromised, have other medical issues such as lung disease and other types of cancer, liver disease, kidney disease, and people with pneumonia. This virus has infected people of all ages so everyone must adhere to the guideines being established by CDC and their individual state governments. A person who has contact with an infected person can transmit the virus to someone else so social distancing is important. There are even concerns now regarding asymptomatic people spreading this virus, but it is an active area of investigation. The CDC also stated that currently it should be treated as viral pneumonia. Unfortunately, no one drug has been shown to be the answer for treatment, however, various drugs are being tested.
Patients Under Investigation (PUI) have shown the following symptoms:
- Lower respiratory condition
- Shortness of breath
Not all infected persons have fever at onset but may have fatigue, diarrhea, headache, sore throat.
Employees who meet any of the Epidemiologic Risks should notify their employer and consult with their personal physician regarding treatment. The Criteria for Return to Work for Healthcare Personnel with Confirmed or Suspected COVID-19 (Interim Guidance) should be followed for employees who want to return to work after being infected with COVID-19.
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.
WATCH INTRO VIDEO - Bloodborne Pathogens: Re-examining Your Exposure Controls (including Infection Control) for the Dental Environment:
Learn more about other safety topics:
|New TB Guidelines, Compliance & OSHA's Inspection Criteria||Proper Removal of PPE for Infection Control||3 Steps to Warding Off the Flu|
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