The ABCs of PPE

DATE: June 2020
AUTHOR: Louise Sinclair

Following the onset of the COVID-19 outbreak, the American Dental Association (ADA) recommended that dental offices remain closed to all but urgent and emergency cases in order to minimize transmission. However, with dental offices now in the process of re-opening, dental hygienists will be keen to know how they can protect colleagues, patients, loved ones, and themselves as they return to work.

The critical role of PPE

COVID-19 is transmitted via contact, droplets and aerosols. The Occupational Safety and Health Administration (OSHA) has provided guidance for dentistry workers and employers, including guidelines on the use of proper PPE. The CDC updated its guidance on May 19 2020.

Masks

When treating well patients (i.e., patients who do not have a febrile temperature or other symptoms associated with COVID-19), provided the procedure is not an aerosol-generating procedure, a single-use, disposable surgical face mask is recommended by the CDC and OSHA. A surgical face mask offers protection against large droplets, spray, splash and spatter.

For well patients receiving aerosol-generating procedures, a NIOSH-approved N-95 respirator is recommended, or a respirator that offers a higher level of protection such as other disposable filtering face-piece respirators, powered air-purifying respirators (PAPRs), or elastomeric respirators, if available.

Unlike a surgical face mask, an N-95 respirator fits tightly to your face to provide a seal and offers protection against aerosols in addition to large droplets, spray, splash and spatter. The U.S. Food and Drug Administration also provides a list of FDA-authorized equivalent non-NIOSH-approved respirators that may be used if NIOSH-approved respirators are not available.

Patients suspected or diagnosed with COVID-19 should not be seen for any care that is not an emergency. If medically necessary emergency care is required, an N-95 respirator or higher-level respirator should be used for all treatment provided, including procedures that do not generate aerosols.

Eye protection

Eye protection consisting of protective eyewear with solid side shields, goggles, or a full-face shield, should be worn during all procedures.

Protective attire

The CDC recommends that a clean gown or other protective clothing that covers personal clothing and skin (e.g., forearms) be worn during procedures likely to generate splashing or spattering of blood or other body fluids, or exposure to other potentially infectious materials. Gowns and protective clothing should be changed if they become soiled. OSHA recommends a gown or protective attire for all non-aerosol-generating procedures in well patients. For all other procedures performed during the COVID-19 pandemic, OSHA recommends a gown.

A clean gown should be donned whenever you enter a patient area, and placed in a dedicated container for waste or linen after each use. Disposable gowns should be discarded after each use, and cloth gowns or other protective clothing should be laundered after each use.

Gloves

Standard precautions include the use of single-use, disposable, non-sterile gloves for patient care other than surgical procedures. For surgical procedures, single-use, disposable, sterile gloves are recommended.

It is recommended that gloves be donned before entering a patient area/room, and doffed and discarded before leaving the patient area/room. If gloves become torn, punctured or heavily contaminated, they should be removed and discarded, hand hygiene performed, and replacement gloves donned. Hand hygiene should always be performed before putting on gloves and immediately after removing them.

Should you wear hair or shoe coverings?

Hair and/or shoe coverings are optional. No formal recommendations have been made in the guidance on the use of these coverings.

Donning and doffing PPE

The CDC refers all dental professionals to the standard guidelines on how to don and doff PPE. Note that the CDC guidance does provide suggestions on where to don and doff specific PPE.

Dealing with PPE shortages

Due to unprecedented demand, PPE shortages have been and still are being reported. If you are concerned about PPE shortages as your office re-opens, the CDC offers strategies for optimizing the supply of PPE. These strategies include understanding your utilization rate and burn rate, along with alternatives and methods to prolong your existing PPE inventory.