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COVID-19: Implications for Returning to Practice

Dr. Robert Carroll, Chief Dental Advisor (Published: 14 May 2020)

It now appears that dental offices will be allowed to open before Covid-19 is totally eliminated as a risk to patients and health care workers. Opening will be conditional on dental offices following all IPAC guidelines currently in place as well as potential new requirements. A new reality will be the much higher likelihood that your practice may be subject to an inspection by public health. To understand why it is important to understand the circumstances that trigger inspections of dental offices.

There are two circumstances that result in an IPAC inspection being ordered for a dental office. The first is due to an outside complaint either to RCDSO or Public Health. Prior to Covid-19 this was the most common reason and thankfully relatively rare. The second circumstance is due to the obligation Public Health has to do contact tracing when they receive notice of a diagnosis of infections such as HIV, Hepatitis [A,B,C], TB, STDs and some others. It is mandatory for registered health care professionals that diagnose these conditions to report this information to Public Health. Covid-19 is now included as a mandatory reporting condition.

When Public Health is notified they must interview the patient to try to determine where the patient may have contracted the disease. This is called contact tracing and Public Health has indicated that this will be significantly ramped up as a condition for reopening. If the contact tracing of a Covid-19 positive patient indicated to Public Health that the patient's dental office could be a suspect they would be required to inspect the dental office. In the past for the mandatory reported diseases it would require more than one patient under investigation to have the same dentist to initiate the office inspection and, fortunately, this has been rare. The low numbers of the population with those infectious diseases and the unlikely coincidence that more than one patient from the same dental office may be diagnosed in the same time period is the reason few inspections took place as a result of this contact tracing. Covid-19 on the other hand has a very high relative infection rate in the public and due to extensive testing going on it becomes more likely that a patient that attends a dental office may test positive to the virus at some point within the 14 day danger zone. This does not mean that they contracted the virus in the dental office. Most likely they would get it somewhere else but, nevertheless, the dental office has to be ruled out. And to add to the risk, only one patient will be enough to trigger the inspection due to contact tracing protocol for Covid-19.

Your SterilWize system will be a great asset should this happen to you. Not only will you be able to demonstrate the documentation necessary but you will also be able to show how the work flow system provides important monitoring as well as the helpful resources the software provides to staff to enable them to achieve the IPAC requirements. Public Health units across Ontario are familiar with SterilWize and understand its many benefits. As a result, the inspector will view your office as one that is dedicated to IPAC excellence. But total immunity to a fussy inspector is not guaranteed. Other important requirements such as PPE, packaging and storage standards, and new requirements specific to Covid-19 such as pre-appointment screening will also be under review. Prior to opening we recommend an IPAC staff review in general with additional training on any new requirements. SterilWize would be happy to assist you with this review. Please contact Susan McGuire should you wish to find out more information on this service.

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