On 24th November, the UK Health Security Agency published new guidance for infection prevention and control (IPC) in health and care settings, focusing on seasonal respiratory viruses, especially COVID-19, influenza and respiratory syncytial virus. This guidance supersedes the previous UK IPC COVID-19 guidance.
The IPC Dental Appendix was also updated in line with the guidance. This applies to all areas of dentistry including both NHS dentists and private dental practices. The Chief Dental Officer (CDO) for England, Sara Hurley, subsequently published an updated SOP for dental teams, which has been updated to complement the IPC guidance.
The main change for dentists is the introduction of a risk-based, two-pathway approach. Dental practices and staff should make sure that they are aware of the changes and follow the new guidance to protect themselves and patients.
Key changes to the overall UK IPC guidance
The main changes to the UK IPC guidance include removal of the three COVID-19 specific care pathways (high, medium and low) and addition of a section on the criteria to be applied within the ‘hierarchy of controls’ to further support organisations/services with maximum workplace risk mitigation.
New recommendations to be aware of are:
- Universal use of face masks for staff and face masks/coverings for all patients/visitors within health and care settings over the winter period.
- Physical distancing should be at least 1 metre, increasing whenever feasible to 2 metres across all health and care settings.
- Physical distancing should remain at 2 metres where patients with suspected or confirmed respiratory infection are being cared for or managed.
- Screening, triaging and testing for SARS-CoV-2 should continue over the winter period. Testing for other respiratory pathogens will depend on the health and care setting according to local/country-specific testing strategies/frameworks and data.
New clinical pathways for dental practices
With removal of the three COVID-19 specific care pathways, the new guidance in the Dental Appendix recommends use of a screening tool to determine which of two clinical pathways patients should take within a dental practice.
Non-respiratory pathway (patient has answered NO to all screening questions):
- Complete the appointment applying standard infection control precautions (note: country-specific requirements may be in place for testing prior to aerosol generating procedures [AGPs]).
- Physical distancing should be at least 1 metre in all areas where possible, for example when not providing direct clinical care. Patients may sit in waiting rooms together provided a physical distance of at least 1 metre can be maintained. This should be increased to 2 metres whenever feasible.
- Face coverings are acceptable for patients.
- Dental treatments, both AGP and non-AGP, can go ahead without fallow time.
Respiratory pathway (patient has answered YES to one or more screening questions):
- If possible, based on a clinical assessment, reschedule the appointment until resolution of symptoms, the end of the isolation period or a negative test result.
- Transmission-based precautions (TBP) should be applied in addition to standard infection control precautions. This includes appropriate personal protective equipment (PPE) and respiratory protective equipment (RPE) according to the setting/treatment.
- Patients should be separated, in time or space, from patients on the non-respiratory pathway. Refer to local arrangements as to where treatment should be carried out.
- Provide patients with surgical masks type II or type IIR in place of a universal face covering.
- Physical distancing of at least 2 metres is required.
- For patients undergoing AGPs, TBPs apply and post-AGP downtime is required. Only essential staff necessary to undertake the procedure should be present.
- Carry out any AGP procedures at the end of the day or clinical session to minimise the impact of fallow time on other patients.
Implications of Omicron for IPC measures
With the current surge in COVID-19 cases and spread of the highly transmissible Omicron variant, dentists have questioned whether the new guidance still applies.
Sara Hurley provided an update, in which she wrote: “Dental practices should continue to see patients in line with our infection prevention control guidelines, with the standard operating procedure helping you implement them in practice.”
She added: ”if as new evidence emerges the IPC requirements need to change, the guidance will be updated.”
She also urged dental team members to get their COVID-19 vaccinations and booster. The Department of Health and Social Care has announced that individuals undertaking Care Quality Commission regulated activities in England must be fully vaccinated against COVID-19 by 1st April 2022. This will apply to staff in both NHS and private practices. NHS England has written to all dental practices with more details of the requirement.
The CDO also asked dentists to complete the England Dental Working Patterns Survey from NHS England to help better understand views on the challenges presented by the pandemic and the measures put in place (deadline Sunday 9 January).
Please do not hesitate to contact Dental Defence Society if you need dento-legal support related to infection control precautions.