City Tech Reopening Plan

Attachment A. Reopening Dental Hygiene Floor

Dental Hygiene Department

Plan for Re-opening the Dental Hygiene Floor

Academic Building A710/711/713

Prepared By: Dr. Maureen Archer-Festa
Dr. Gwen Cohen-Brown

Dentistry and the Dental Hygiene profession has always maintained a high standard of infection control procedures to assure that any dental patient can receive dental services without fear of contracting a communicable disease.

During the 1980’s, when HIV became a public health crisis both the dental and medical professions were challenged to re-think the existing infection control procedures. HIV disease is a blood borne pathogen which dramatically altered how the delivery of dental/dental hygiene care was delivered.

All the infection control procedures initiated during the 1980’s are still in practice today and have been very effective in the prevention of all the blood borne pathogens (HIV/Hepatitis B/Hepatitis C). The infection control principles of the 1980’s were founded on the concept that all people should be managed as if they are potentially infectious. In the dental hygiene department, we adhere to the Centers for Disease Control and Prevention's (CDC's)Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings andOSHA's Bloodborne Pathogens standard (29CFR 1910.1030).

Presently in this current public health crisis, SARS-CoV-2 the etiology of the COVID19 disease, is challenging the dental and dental hygiene professions to once again re-think the existing infection control processes to mitigate any risk of potential transmission in the dental setting. Unlike HIV, which is a blood borne pathogen, SARS-CoV-2 is primarily transmitted through the respiratory system. Therefore, modifications to the existing infection control practices will include strategies to minimize exposure to respiratory or airborne droplets. From a review of the literature, the best practices to control the transmission of this virus are to decrease the exposure to respiratory particles from the respiratory system and frequent hand washing. So, although not easy, steps can be implemented in the dental care setting to minimize the risk of transmission of the virus between the patient and the healthcare provider. Additionally, strategies to minimize virus landing on fomites/environmental surfaces in the dental setting may be a potential source of transmission although it is considered to be in the low risk category. (https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/how-covid-spreads.html On a positive note, the SARS-CoV-2 virus is easily killed with soap and water on persons and Tuberculocidal-level disinfectants on environmental surfaces, utilizing washing and disinfection practices are already standard in the dental profession.

Until a vaccine is developed, for the foreseeable future, the non-pharmaceutical measures (social distancing/face coverings) will be used to reduce the risk of transmission. While the SARS-CoV-2 is easily transmissible in people in close contact, its transmissibility decreases with social distancing. A recent article published in the Lancet (https://doi.org/10.1016/s0140-6736(20)31142-9) reviewed the significance of the combination of non-pharmaceutical, social distancing, face coverings and eye protection and determined that they dramatically reduce the potential of SARS-CoV-2 transmission. This review supports the measures of facemasks/eyewear and social distancing as strategies which are very effective at reduction of viral transmission. The scientific literature is providing a rational, logical approach to re-opening dental settings to minimize the transmission risk of SARS-CoV-2 if we are willing to implement procedures to minimize respiratory exposure.

In dentistry, we are exposed to potential airborne transmission of SARS-CoV-2 through the respiratory tract, but by modify the existing standard of care infection control measures, we can add another layer of protection by either wearing a N95 or approved KN95 or a level three medical mask in conjunction with a disposable face shield which, if used properly, will eliminate exposure to the patient’s respiratory droplets.

Rationale for re-opening the NYCCT Dental Hygiene Clinics:

  1. The standard infection control procedures have demonstrated a 30-year history at reducing the risk of disease transmission in the dental setting
  2. The Dental Hygiene faculty are all highly knowledgeable and practice excellent infection control measures.
  3. The Dental Hygiene students have had infection control training and are closely monitored to ensure they maintain asepsis.
  4. The modifications of the infection control practices can be implemented to decrease the risk of infection with SARS-Co-V-2

Preparing the 7th floor for re-opening the Dental Hygiene Clinical Areas:

All Bathrooms/ floors/seating should be cleaned and disinfected by the College buildings and ground employees

Due to the long period of closure, the entire clinical areas (radiology rooms/clinics and dental materials labs) must all be:

  1. Cleaned and then disinfected using an intermediate-level disinfectant
  2. All instruments must be sterilized
  3. The Soil and Clean room will be cleaned and disinfected
  4. All maintenance and testing of the equipment in the clean and soil room will be performed.
  5. All waterlines will be shocked, and all the water will be tested
  6. Waterlines within the clinical areas will be purged and shocked two weeks then one week prior to re-opening the clinical area.
  7. Waterlines will be tested after the shocking, prior to re-opening

Building Physical Considerations (Facilities Management)

  1. Air circulation:
    1. Air movement and filtration will meet required specifications.
  2. Bathrooms cleaning and disinfection will be managed by the College’s building and grounds.
    1. Two possibly three of the couches will be moved behind the closed double doors which enter the Dental Hygiene clinic. This will create a pre-screening area.
    2. The remaining furniture can be put into a storage closet or roped off so people will maintain social distancing.
  3. Dental material labs:
    1. Create social distance markers on the floor to identify work areas
    2. Dental Hygiene students supervised by faculty will disinfect prior to and after using this space.
  4. Clinical area:
    1. The hallway double doors which separate the lobby from the Dental Hygiene clinic will be kept in a closed position
    2. Seating in the Pre-screening area will be arranged to promote social distancing and disinfected hourly using and intermediate-level disinfectant by the dental hygiene staff.

DH Faculty/Students/CLT and Staff:

  1. Education and training to assure that all the COVID19 prevention of transmission procedures are incorporated to the daily Dental Hygiene functioning of the DH clinical areas
  2. Review of required PPE and mask type base upon task and risk of aerosol
  3. Practice donning and doffing of PPE

Overview of Movement and Social Distancing within the Academic Building

The required signage from CDC “Stop the Spread of Germs” will be posted by the main building entrance, by all elevators and at the entrance to the Dental Hygiene clinical areas.

  1. Prior to a scheduled Dental Hygiene appointment:
    1. All patients scheduled for the dental hygiene clinic will be asked pre-appointment screening questions by phone using the ADA patient screening form. (insert link)
    2. Patients with all “no” responses will be advised to come in for dental hygiene services
    3. Patients with “yes” responses to any question other than being over 60 years old, will be advise the patient to postpone elective dental hygiene care.
  2. Entering the Academic building
    1. All people (faculty /staff/students/visitors) will be required to have a face covering (mask) the entire time they are in any of the academic building public spaces.
    2. Face mask use within the classroom will be determined by the ability to social distance or if the person is having Dental Hygiene services.
    3. All people will enter the building through the designated entrance.
    4. Thermal scan temperature check- one person will stand behind 2 turnstiles. This person will scan the foreheads of people entering the building.
    5. No temperature/respiratory symptoms/wearing facemask-permitted in the building.
    6. Temperature ≥ 100.4 F, person doing thermal scan identifies to security, not permitted in the building.
  3. Movement within the Building
    1. Floors 1 to 5 will be escalator use only
    2. Escalator in lobby to be used with social distancing (6 feet) and disinfection of handrails every 2 hours
    3. Main lobby elevators will be controlled to move from lobby to the 6th through 8th floors only.
    4. The elevators will be programmed with automatic stops at each floor 6 to 8.
    5. High touch surface- buttons will be covered and not available for use.
    6. Limited volume of people to promote social distancing and social distance floor markers will be utilized.
    7. Freight elevators- designed to stop at each floor for handicap accessibility.
    8. High touch surface buttons are to be covered and not available for use.
    9. Egress from the building will be the exit which goes directly to Jay Street, next to the first- floor classroom
  4. Arriving on the 7th floor
    1. All Dental Hygiene faculty/staff/students will disinfect hands upon exiting the elevators on the 7th floor.
    2. All Dental Hygiene faculty/staff/students Go to their designated changing areas and put on clean dental scrubs, washable head scrub cap and designated clinic shoes.
    3. Shoes worn while traveling will not be permitted into the clinical area.
    4. Patients scheduled for dental hygiene services, will be greeted at the elevator by their assigned student who will directly escort to the clinic prescreening area and patients will use a hand sanitizer.
    5. Only the scheduled patient without accompaniment will be permitted in the Dental Hygiene Clinic.
  5. Pre-screening area (located behind the hallway double doors)
    1. Assigned DH students & supervising DH faculty member will provide the COVID screening.
    2. Hand sanitizer will be used by all patients.
    3. Temperature check can be done at this location, if the College does not allow thermal scans at the main entrance.
    4. In the prescreening area, the patient will be screened for COVID 19 symptoms or contact with COVID 19 infected persons:
      • Answer the will be asked pre-appointment screening questions using the ADA patient screening form
      • Thermal scan temperature will be taken if it is not done at the main building entrance.
      • Blood pressure screening
    5. Patients without signs of COVID 19, including being afebrile as well as having a normative blood pressure, will be escorted into the DH clinic for Dental Hygiene services.
    6. All patients will be asked their COVID-19 status, if they have been tested, if they had COVID-19 and if they know their antibody status in the prescreening area.
    7. Patients who based upon the screening may be at risk of a COVID 19 infection, will be asked to consult with their physician and seek COVID 19 testing. No dental hygiene services will be performed. They will be escorted out of the building.
  6. Entering the Dental Hygiene Clinic
    1. Patient and assigned student walk to their assigned cubicle
    2. Once seated patient may remove the mask and use the pre-procedural rinse
    3. Now all procedures will follow the Dental Hygiene appointment ready reference
  7. Exiting the clinic
    1. At end of the appointment, patient will use alcohol-based hand sanitizer prior to leaving the dental chair and a post procedure rinse, place the mask on their face.
    2. The patient is escorted to the elevator; social distancing is monitored and the Dental Hygiene appointment ends.
    3. Security in the lobby directs the patient which exit to use.

Scheduling of Dental Hygiene Patients:

Prior to a scheduled Dental Hygiene appointment:

  1. All patients scheduled for the dental hygiene clinic will be asked pre-appointment screening questions for COVI 19 using the ADA patient screening form.https://success.ada.org/~/media/CPS/Files/Open%20Files/ADA_Return_to_Work_Toolkit.pdf
  2. Patients with all “no” responses will be advised to come in for dental hygiene services
  3. Patients with “yes” responses to any question other than being over 60 years old, will be advise the patient to postpone elective dental hygiene care.
  4. DH appointments scheduling will limit the number of patients in the dental hygiene clinical spaces to maintain physical distancing of 6 feet (see clinic diagram)
  5. Patients will always wear face coverings unless they are in the dental hygiene cubicle and dental hygiene care is being delivered.