The reduction in the incidence of Covid-19 in the community is one of the reasons why we are now more confident to return to treat our Patients. It does however put a responsibility on us not to start producing Clusters as a result of Dental Practices effectively having to cocoon themselves with their patients. We will now have all the individual members of the team coming from their safe family unit, to be joined by patients, in conditions which will not allow for social distancing. In effect we could be setting up a potential source of Covid19. Could this be the origin of A Dental Practice Cluster?

Notwithstanding the new practice environment created after many distraught weeks of Risk Assessment and Due Diligence, we now have to follow Our Own Decision on Duty of Care. This needs to be a Team decision. Doubts must be expressed and dealt with.

The close contact with the patient during treatment, a high-risk of AGPs, even strict adherence to all the new protocols, may not prevent incidents where attention is distracted and mistakes will be made. Do we know sufficient about the timing and effectiveness of our disinfecting and sterilization procedures and protocols? Did we practice enough? Do we fully understand what we are doing?

All this points to,
Assess your Habits,
Change your Habits,
Affirm your Habits.

When did you last touch your face, touch a surface, cough or sneeze in an unprotected way, spend longer than necessary close to a colleague, not check the disinfecting process necessary for the last procedure you did? In the private family situation have we all maintained strict protocols? If not, you will have to change your habits.

This will need for us, as individual professionals and part of a team, to assess ourselves and the team. Be open about failings, and help others who may feel underconfident, to bring up any issue they are concerned about. This is a team effort and not individuals in a team. Remember how we dealt with the past? HIV and Hepatitis?

Who is in charge of what? Do we all know the overall plan to bring our Patient from Initial Phone Triage, through Arrival, into Treatment, and then successfully Discharged? All the team have to get safely Home! Public Transport! Safe??

It appears that the legitimate authorities in control of our profession are telling us to go forth, but we seriously hope not multiply. We must abide by the protocols of triage twice, the presence of suitable sterilization, disinfecting, PPEs, the informed agreement of our patients and our control of AGPs.

Our history of adapting and adjusting to the presence of HIV and Hepatitis in our communities is going to be seriously tested. Our strict adherence to the new protocols, many of which we have been practising before this Pandemic, will prevent the development of outbreaks of Covid-19 in Dental Practices.

When communicating with patients, it is essential that you are clear exactly what the various procedures your patient has to go through.

Practice the advice and instructions you are sharing with them. The patient will be going through some new experiences on their journey to, and through treatment, and they will welcome anybody who is being helpful and clear in guiding them. When you are chairside, communicate with them so they understand the new treatment procedures.

Since personal contact is no longer allowed, and because our faces will be covered with at least two layers of protection, eye to eye contact is going to be very difficult. The tone of your voice will be important as you reassure them. Check that all the protective protocols are being followed. No slipping mask, no punctured gloves. Leave the floor alone. Can you access new instruments easily? This will require us to arrive at work mentally prepared to abide strictly by no physical contact with anybody.

Respect colleagues, move back move aside, ensure your face is adequately covered and your hands are avoiding contact with surfaces. Communicate clearly! Know your responsibilities and your duties in the team. Question those them and confirm and affirm your colleagues. Being prepared to do these things will build team spirit and improve safety.

Upwards of three to even twenty people in larger practices of team members and patients all from different family groups will now be in close proximity for many hours at a time. Is this going to produce a dangerous journey for both the patient and the team? No, if we are constantly checking and communicating, encouraging and affirming. Do no Harm. We have done it before.

We are learning new things every day, new equipment which gathers up the AGPs at source hopefully could be a major innovation in infection control. Sharing information now made easy by WhatsApp, will provide a continual exchange of procedures that worked and importantly what failed.

Our behaviour over the next weeks will make the following months successful if correct procedures are rigidly and automatically preformed as a well-trained team will do. Make the mistakes during rehearsals before the patients come. Continually refer to the protocol sheets which everybody in the team must know. The consequences of failing to follow each procedure correctly could be serious either dentally or because of cross infection.

On a daily basis is there anything that can be added to re-establish social distancing at everywhere other than in the surgery. This might be the one of many questions to be asked by the team, of the team. Our responsibility to prevent any spread of Covid-19!

We now must be tested in a regime of rapid response. When will this be possible? An effective vaccine and a medical passport will eventually bring some reality, and conditions which will allow us to continue working safely. Can Social Distancing be safely discontinued??

Authorities where are you? Please no pandering to Civil Liberties. Lives could be at risk here.

Angus P Roche PositivePractice.ie

INSPIRED BY LIFE IN DENTISTRY MAY 2020