2019 Novel Coronavirus (COVID-19) - ADA Update

Last Updated:March 16,2020

The Centers for Disease Control and Prevention provides important and up-to-date information to the public and healthcare providers on the status of reported cases of 2019 Novel Coronavirus (COVID-19) across the United States. Initial cases were reported in Wuhan, China and it is currently thought that the most likely mode of transmission is human to human. There are several reports of transmission from an asymptomatic person with the infection, so there remains much to be learned about how COVID-19 spreads.

DentistsareurgedtoviewtheCDCCOVID-19situationsummarywebpageforcurrentinsight (https://www.cdc.gov/coronavirus/2019-ncov/summary.html).Theriskoftransmissioninthe UnitedStatesislowatthistime.Standardprecautionsshouldbetakenwithallpatients,atall times.

Availabilityof Personal Protective Equipment

The CDC has not changed its guidance on single-use disposable facemasks, which are regulated by FDA to be single use and should be worn once and discarded.

Page 41 of the CDC Guidelines for Infection Control in Dental Health-Care Settings has the following guidance:

1. Wear a surgical mask and eye protection with solid side shields or a face shield to protect mucous membranes of the eyes, nose, and mouth during procedures likely to generate splashing or spattering of blood or other body fluids;
2. Change masks between patients, or during patient treatment if the mask becomes wet.

CDC urges Dental Health Care Personnel (DHCP) concerned about healthcare supply for PPE to monitor HealthcareSupplyofPersonalProtectiveEquipment for updated guidance, and to be familiar with the InterimInfectionPreventionandControlRecommendations.

The CDC guidelines notes that, in cases when a patient presents with symptoms of a respiratory infection, DHCP may consider postponing non-emergency or elective dental procedures until a patient is no longer contagious with diseases that may be transmitted through airborne, droplet, or contact transmission (e.g., sneezing, coughing, and contact with skin).

If urgent dental treatment is necessary, DHCP and medical providers should work together to determine the appropriate precautions on a case-by-case basis to avoid the potential spread of diseases among patients, visitors, and staff. Because dental settings are not typically designed to carry out all of the Transmission-Based Precautions that are recommended for hospital and other ambulatory care settings, DHCP and medical providers will need to determine whether the facility is an appropriate setting for the necessary services for a potentially infectious patient.

Prevention of Suspected RespiratoryDisease Transmission in theDental

Healthcare Setting

Patients with an acute respiratory illness may present for dental treatment at outpatient dental settings. The primary infection control goal is to prevent transmission of disease. CDC recommends a multi-step approach that begins before the patient arrives at the practice and includes guidance regarding their arrival and for the complete duration of the affected patient’s presence in the practice.

It may not be possible to know the cause of any patient’s illness so it is important to follow this guidance and standard precautions at all times.

Infection control issues during patient assessment:

• Patients with an acute respiratory illness should be identified at check-in and placed in a single-patient room with the door kept closed.
• Seek to prevent the transmission of respiratory infections in healthcare settings by adhering to respiratory hygiene/cough etiquette infection control measures at the first point of contact with any potentially infected person https://www.cdc.gov/flu/professionals/infectioncontrol/resphygiene.htm
• Offer a disposable surgical mask to persons who are coughing; and provide tissues and no-touch receptacles for used tissue disposal.
• Ill persons should wear a surgical mask when outside the patient room.
• Dental healthcare personnel assessing a patient with influenza-like or other respiratory illness should wear disposable surgical facemask*, non-sterile gloves, gown, and eye protection (e.g., goggles) to prevent exposure. Since recommendations may change as additional information becomes available it’s a good idea to check the CDC website for COVID-19 updates at https://www.cdc.gov/coronavirus/2019-nCoV/hcp/infection- control.html
• Patient and dental healthcare workers should perform hand hygiene (e.g., hand washing with non-antimicrobial soap and water, alcohol-based hand rub, or antiseptic handwash) after possible contact with respiratory secretions and contaminated objects/materials.
• Routine cleaning and disinfection strategies used during influenza seasons can be applied to the environmental management for COVID-19. More information can be found at http://www.cdc.gov/ncidod/dhqp/gl_environinfection.html.