Dental laboratories must ensure that their infection control procedures and policies are working to protect their workers. Here you'll find some helpful Q&A from the NADL and SafeLink Consulting Webinar : COVID-19 Safety and Infection Protection Guidance for Dental Laboratories held on April 1, 2020. Learn more about COVID-19 infection control in the dental laboratory in this short video:
Q: Can you please provide a brief overview of the disinfecting process for receiving cases?
A: All items must be cleaned before disinfecting. If no dried blood is evident, then rinsing with water is effective. Dried blood must be removed prior to disinfecting. The item should then be sprayed or immersed, based upon the manufacturer’s instructions for the impression material, and remain wet
for the amount of time to kill TB and for inactivation of SARS-Cov2 (COVID-19). The disinfectant should then be rinsed away prior to sending the case items into manufacturing. The disinfectant must either state that it is effective against Human Coronavirus or must be on the EPA list for emerging Pathogens.
Q: Is Cetylcide II an effective disinfectant against Human Coronavirus?
A: Cetylcide II is on EPA’s list of disinfectants that inactivate Human Coronavirus. According to the manufacturer’s instructions for use, items must be wet for 10 minutes. CDC recommends that, where blood may be present, a high-level disinfectant with a Tuberculocidal claim should be used. Cetylcide II does not state that on the label. This product is a corrosive material, so review the Safety Data Sheet for safety precautions.
Q: What or who will help control price gouging for PPE? And sterilization liquids?
A: The states are allowed to enact laws that protect the public from price gouging during an emergency situation. Laws vary from state to state, so contact the state attorney general’s office to find out the laws in your state.
Q: Is sodium hypochlorite (bleach) effective in treating impressions?
A: A sodium hypochlorite (bleach) solution is still one of the most reliable, economical and effective disinfectant solutions. The solution must be 1 part sodium hypochlorite to 10 parts water and the items or surfaces must remain wet for 10 minutes. The product is corrosive, so follow safety precautions for use from the manufacturer. In order to be able to cite a recognized source if ever questions about the disinfecting chemical being used, we recommend following the CDC’s guidelines for dentistry and they recommend an intermediate-level, hospital-grade disinfectant with a TB kill. If this information is on the label of the disinfectant, then it would meet this requirement by the CDC.
Q: Does OSHA require we provide a laundry service for all of my employees PPE?
A: Employees are not allowed to self-launder any PPE. Any protective garments must be either laundered onsite or laundered by an outside service.
Q: Will ultraviolet (UV) light kill this virus?
A: Because this virus is so new, there has not been much information on the use of UV. UV light has been shown effective in inactivating other coronaviruses, so it is likely that it would do so with SARSCov2 (COVID-19) since the structure is similar to the other viruses. All areas of the item being disinfected must be exposed to the light. A study was performed on UV disinfecting of impressions and is part of the National Institutes of Health.
Q: Can you use ultraviolet (UV) light to disinfect outgoing cases?
A: There is evidence that UV light is effective at inactivating viruses on hard surfaces ranging from cell phones to entire hospital rooms. UV dental cabinets can be used to disinfect instruments, so ultraviolet (UV) light should do the same on outgoing cases. It is important to investigate any product and its disinfecting claims as well as its safety for the user. Human exposure to UV light can be very dangerous.
Q: We talk about washing hands often, what about washing your face?
A: Hands are the primary surface contact and transmission source to the eyes, nose and mouth, so should be washed often. Areas of the face may be subject to exposure, so should be washed after potential exposure.
Q: Regarding the OSHA “reporting” requirement for confirmed COVID-19 cases…how does one go about determining if they contracted COVID-19 from "work" or the "supermarket"?
A: The requirement for “reporting” to OSHA is the death or in-patient hospitalization of an employee because of a work-related injury or illness. COVID-19 can be a “recordable” illness on the OSHA 300 log only if a worker is infected as a result of performing their work-related duties. Employers must try as best they can to determine if it is work related. You should first investigate how the employee could have been exposed at work, such as working with a suspected or confirmed COVID-19 employee or patient. Document the investigation on an incident report. If the employee is confirmed to be COVID-19 positive then it would be recordable because of the required days away from work. Also, if treatment beyond first aid is required then it would be recordable. If exposure at work can be eliminated then it is not recordable.
Q: Can you please explain the reasoning for "double wipe down" of surfaces?
A: The first wipe is the cleaning wipe to remove any bioburden or other surface contaminates. Disinfectants only work on the surface they touch. They cannot penetrate through any surface contaminate. The second wipe is laying down the disinfectant.
Q: What are the "oils" that N95, NP95, etc. prevented?
A: The “oils” are industrial oils. This is information on the types of respirators from NIOSH. “An N-95 respirator is one of nine types of disposable particulate respirators. Particulate respirators are also known as “air-purifying respirators” because they protect by filtering particles out of the air as you breathe. These respirators protect only against particles—not gases or vapors. Since airborne biological agents such as bacteria or viruses are particles, they can be filtered
by particulate respirators. Respirators are rated as N, R, or P for protection against oils. This rating is important in industry because some industrial oils can degrade the filter performance so it doesn’t filter properly.* Respirators are rated “N,” if they are Not resistant to oil, “R” if somewhat Resistant
to oil, and “P” if strongly resistant (oil Proof).” CDC & NIOSH Respirator Fact Sheet
Q: Should we be disinfecting the boxes we deliver the cases in?
A: It is not required. It is very difficult to disinfect cardboard and paper and retain their integrity. Practicing Standard Precautions should eliminate the need to disinfect the delivery boxes.
Q: How long after a model is prepared from impression would it be considered 'safe'?
A: If the impression has been disinfected properly then the model should not be contaminated with coronavirus so it should be safe to handle immediately. If the impression has not been disinfected then the model would need to be disinfected.
Q: Can you address the need for lab coat protection that completely covers street clothing for those in high risk area?
A: Any exposed uniform or street clothing that could be contaminated due to splash or spatter of body fluids or touched by contaminated gloves might carry the virus wherever the employee goes in or out of the workplace.
Q: How long should we expose the restoration to 70% alcohol to effectively disinfect it before delivery to office?
A: According to reviewed studies, the minimal contact time is 30 seconds to be virucidal. You should ensure that the material is not negatively affected by the alcohol.
Q: Do we need to disinfect cases leaving lab before final shipping to dentist?
A: Disinfection is not required except for a few states. During this pandemic, it might be expected by your dental client. The dentist should be sterilizing or disinfecting anything that is placed in the mouth.
Q: How do I give my doctors some CLEAR and CONCISE guidance on sanitizing the many different kinds of impression materials?
A: The CDC’s 2003 infection control guidelines for dentistry states that “The best time to clean and disinfect impressions, prostheses, or appliances is as soon as possible after removal from the patient’s mouth before drying of blood or other bioburden can occur.” The CDC also recommends that the dentist and the dental laboratory communicate regarding the cleaning and disinfection procedures. You should ask the manufacturer to provide the best disinfection protocol for their specific material and provide that to your clients. Using disinfectants that require the least amount of contact time necessary to be effective would be a best approach.
Q: How long can the disinfectant stay on the impression before affecting the alginate properties? Would it be a good idea to soak it in soapy water?
A: The impression should be rinsed immediately and then disinfected by using the 1:10 ratio of sodium hypochlorite and water for no more than ten minutes. The impression should be rinsed immediately after the ten minutes. The impression should not be soaked.
Q: Do dental laboratory technicians need to wear PPE while performing all phases?
A: Technicians who are not performing tasks where potential exposure to body fluids are expected would not be required to wear PPE for protection from this virus. Standard precautions should be practiced, including hand washing, routine surface contamination and physical distancing. New guidelines recommend everyone wearing masks to prevent transmission. The employer may determine it is necessary to protect all employees.
Q: Do items need to be dried before applying the disinfectant?
A: They do not have to be dry however excess moisture should be removed so that that the disinfectant is not diluted by contact with the excess moisture. Drier is better.
Q: When performing an acrylic repair even after disinfecting the prosthesis when grinding to prepare for the repair is that considered aromatic? In other words, should I be wearing a N95 mask or will the standard face mask work?
A: OSHA requires the use of engineering and work practice controls first to eliminate the risk of any biological or chemical exposure. If these are not effective enough to remove or reduce the risk, then PPE would be required and for respiratory protection this means an N-95 or greater respirator. Remember OSHA respiratory protection requirements are very stringent, including medical qualification and fit testing.
Q: Is it better to use a full-face shield in conjunction with a mask / respirator when handling possible infectious materials if you want to reuse masks in order to save on quantity of masks used?
Q: With such a highly contagious and widespread illness, with a 48-hour plus hour of being asymptomatic, how on earth could that be tracked back to being contracted at the lab? What is the reality of this connection being made?
A: It may be very difficult to do. Follow the CDC guidelines for determining the risk assessment.
Q: What practice should we do with normal wear when coming back home?
A: The best practice during this pandemic is to immediately and carefully remove all clothing. Either wash immediately or segregate from contact until washing.
Q: Instead of spraying them, I immerse models and impressions in a container of disinfection liquid for a period of time while changing the liquid daily, is that a good practice?
A: If you have not had any problems with accuracy, then keep doing what you are doing.
Q: Should the paper Rx be separate from the bag? If pouches are not used, will Rx’s stapled to the be contaminated from the little hole made in bag?
A: The Rx should be separated from any contents that have been potentially contaminated. There should be very little risk of contamination of the Rx from being stapled to the bag.
Q: What do you recommend for disinfecting impressions before pour up? Before scan?
A: We do not promote any certain disinfecting product. Any EPA registered disinfectant that is effective against the coronavirus and that you feel does not compromise the accuracy of the impression or model would be best.
Q: If employees want to work - specifically in the shipping/receiving and the disinfecting area, can we ask them to sign a consent form of the risks?
A: All employees should be notified and trained on the risks associated with their specific tasks. The employee can be provided with a job description or job safety analysis and can be asked to sign that they have received the information. All training should be documented. This does not relieve the employer for responsibility for protecting the employee.
As a service to the DLT Community, the webinar referenced in this Q&A was recorded and is available at no charge on the NADL Learner Community platform at http://nadl.learnercommunity.com/. Get free online course: COVID-19 Safety & Infection Prevention Guidance for Dental Laboratories
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