Changes to the practice following the 8th June easing of  COVID-19 Lockdown

COVID-19 is highly infectious and the consequences of contracting it can be deadly. The following measures are designed to identify and minimise the risks of the virus being transmitted during time in the practice, and they will be constantly reviewed. 

After months of lockdown, we are all familiar with the principles that enable us to stay as safe as possible, and these apply to everyone at all times.  A visit to the dentist inevitably breaks social-distancing rules[1] and so extra precautions have been implemented, in line with the many guidelines.

When those guidelines are in conflict, the principles of “The Daughter Test” will be applied, i.e. if the person at the end of the telephone or in the practice was one’s daughter, how would one wish her to be cared for or treated.

EMERGENCY CARE – telephone assessment/triage

Any patient calling the practice will be provided with Clive’s home telephone number (023-8055-8493) so that the patient can discuss their problem with Clive as quickly as possible.

An assessment/triage of the patient will take place and appropriate advice given.  This will need to take place in the absence of the patient’s dental/medical records and will therefore be a preliminary assessment and provision of advice.

EVERYONE

The following groups have been identified as having an increased risk to life if they contract COVID-19:

  • increased age, especially those over 70;
  • men are three times more likely to develop symptoms/complications than women;
  • underlying health conditions[2] can create co-morbidity;
  • pregnancy[3];
  • people of different ethnic groups are affected differently.

Where possible, vulnerable people should continue to be shielded.

With the virus being invisibly transmitted, we can all be suspected of having contracted this virus, without knowing it and without having developed symptoms.  Anyone known to have COVID-19, or other members of their household, should stay at home and so they will not be admitted to the practice.  If you find yourself in this situation, and you have an appointment arranged with us, please let us know as soon as possible so that we can postpone your appointment free of charge.

THE PRACTICE

The two main paths of infection have been identified as: breathing infected droplets; touching contaminated hard surfaces.  To minimise the need for our patients and visitors to touch hard surfaces, the following measures have been put in place:

  • All doors are propped open except where decency and safety demand[4];
  • A hands-free, hand sanitiser is on the reception counter and we invite you to use this on entering and leaving the practice;
  • Magazines have been removed from the waiting room;
  • Payment by credit/debit card is preferred over cash, and the payment machine can be operated by using a tissue[5] as a barrier.

THE RECEPTION AREA

A Perspex screen has been installed on the reception desk, with a slot at its base to enable items to be passed under it.  The reception team also have the use of full-face visors, which are considered to be more effective barriers than face masks in some guidelines.

Surface decontamination will be carried out by our reception team.

Please only use the toilet if absolutely necessary.  If you can possibly wait until you get home, please do so.

Our team are booking space between appointments for two purposes: to minimise the number of people who are likely to be in the practice at any time; to allow Clive and Dawn extra time to sanitise their rooms between appointments.

On the day when Dawn is seeing patients, Clive will be acting as her receptionist.  This will minimise the number of people needing to be in the practice at any time and will enable any examinations, by Clive, to be carried out during your visit.

THE WAITING ROOM

One of our tub chairs has been removed, leaving the sofas and the remaining tub chair socially-distanced.  Please reduce, as far as reasonably possible, your touching of the seating.

We invite you to arrive at the practice as shortly before your appointment time as possible, in order to minimise the time that you will need to spend in the waiting room.  If it is possible, please try to come alone but, when this is not possible, we ask those from the same household to sit together on a sofa.  It would also be appreciated if you could leave such items as shopping bags elsewhere.

THE SURGERY

Clive, in accordance with the published guidelines, has been continuing to see emergency cases during the lockdown[6].  This has given him plenty of time to practice the enhanced cross-infection measures, again in accordance with the published guidelines.

All appointments will be spaced apart to help maintain temporal spacing of patients, and to allow for updated disinfection measures to be carried out in the surgery between appointments.

During the appointment, the following precautions will take place:

  • Only one patient will be in the surgery at any time, unless that patient needs to be accompanied by a responsible adult;
  • Clive will be wearing PPE, appropriate to the procedure;
  • Aerosol-generating procedures will be avoided[7], unless absolutely necessary;
  • The use of rubber dam is an effective barrier and so this technique may be used[8];
  • Clive will have anticipated what instruments and materials may be necessary for the planned work, and these will have been laid out in preparation for your appointment;
  • Any instruments and materials which have been used, and not returned to the bracket table, will be placed on a separate sheet of paper on the units, to prevent them touching the work surface;
  • All single-use items will be disposed of in the appropriate manner;
  • All instruments will go directly into the autoclave. Once they have been sterilised, they will then be debrided and further sterilised where appropriate.
  • All surfaces that have been, or may have been, touched during the visit will be cleaned with medical-grade surface disinfectants, with the next patient’s tray and materials laid out, before that patient is allowed to enter the room.

[1] … even though some have regarded them as mere suggestions!

[2] Hypertension; Cardiovascular disease; Diabetes mellitus; Chronic kidney disease; Chronic obstructive pulmonary disease; obesity.

[3] Over 28 weeks, or those with an underlying health condition mentioned in the previous footnote, are advised to stay at home.

[4] This probably goes against Fire Regulations but the risks of contracting COVID-19 outweigh the risks from a non-existent fire.  In the event of a fire, normal evacuation procedures will take place.

[5] These tissues are in a box next to the machine and we ask that you remove the tissue that you have used, rather than hand it to us.

[6] This was checked by the Care Quality Commission during lockdown.

[7] Aerosol-generating procedures increase the risk of the virus becoming airborne.  Clive is of a vintage where he learned to provide many forms of dental treatment without the need to use aerosol-generating procedures, which are therefore safer techniques than those which produce aerosols.  These techniques are a bit noisier for the patient and take a bit more time. In the case of root canal treatment, the specialist society in that field of dentistry advises that aerosol-generating techniques, creating an enhanced risk of cross-infection.

[8] If you are unfamiliar with this item, it is a sheet of rubber that goes over the tooth and is held in place by a clamp.  You can carry on breathing as normal, through your nose, while it is in place.  Most people cope with it well, especially as it saves all that water and bits going down to the back of your mouth, but some find that it feels claustrophobic.