IPC FAQ

An AGP is any dental patient care procedure that may produce fine aerosolized droplets. AGPs may be produced when you use any of the following instruments or perform these tasks:

• Air-water syringe (using just air, just water or air and water together)

• Alow speed handpiece

• High-speed handpiece

• Cavitron

• Piezo

• Intraoral radiography - may cause gagging or coughing which in turn produces aerosols

A PCRA is the first step in routine practices. It should be done for every patient and every care interaction. The purpose of a PCRA is to help you decide what PPE you should use based on your specific situation. Do the entire assessment by asking yourself these three questions before beginning to don PPE. Remember to include hand hygiene in the process of donning the appropriate PPE. The questions that are involved in the PCRA are simple and easy to remember:

1. Is there a potential that I will be exposed to contaminated items or blood/body fluids? 

   1. If yes, perform hand hygiene and don gloves.

2. Is there a potential that my clothing, hair or skin may become contaminated by sprays or splashes or come into contact with contaminated items?

   1. If yes, clean your hands and then don a head cover and a gown

3. Is there a potential that my face and eyes will be within two meters of a person who might cough/gag/vomit or is there a chance that a splash/spray/aerosol will be created? 

   1. If yes, clean your hands first and then don either an N95 and safety glasses (we are not using N95s currently) or a Level 3 surgical mask and a full face shield

Your face shield should be cleaned each time you remove it. Remember that your face shield, mask and head cover remain in place for an entire clinic, even if you are seeing multiple patients in that clinic. The only time you would remove your head and face PPE in the middle of a clinic is if it became soiled by splash or spray.

With clean hands, remove the shield and place it on the side counter, clean your hands again. Using water from the sink tap and hand soap, gently wash and rinse your shield to remove any particles that might be abrasive and scratch your shield when you disinfect it. Dry the shield with a disposable towel. Don clean gloves, retrieve an alcohol-based disinfectant wipe from the dispensary and disinfect the shield. It is now ready to be stored or used again.

We wipe contaminated surfaces such as counters, hoses, light handles, articulators and lab pans that may have bioburden (aka - saliva, blood, tooth debris, tissue) on them twice because the first wipe removes the bioburden and then the second wipe disinfects. One wipe to clean, then a second wipe to disinfect.

• Clean overgowns (not used in an AGP or otherwise soiled during patient care) can be worn into the Prosth or Ortho Lab. **Lab staff may turn you away if your over gown is soiled**

• All lab pans and articulators must be disinfected prior to leaving the operatory when taking them to the lab.

• All impressions and/or any appliance or prosthesis must be transported to the lab in a ziploc bag.

• Fixed prosth final impressions and bite registrations must be placed in a Cidex bath just inside the lab door with the timer set for five minutes.

• Removable prosth impressions, appliances and prostheses must be disinfected before taking them to the lab. Lab staff will direct you to use the bleach disinfection bath & timer in the Rem Prosth area of the lab, should the disinfection be deemed inadequate by lab staff.

• All lab pans and articulators must be disinfected by the student, resident or staff member for a second time in the prosthodontics lab. There are disinfecting stations in both the fixed and rem prosth areas, ask for details.

• If you don’t know, ask an instructor or staff member.

You must (students & residents) or should (staff & faculty) have immunization against the following diseases:

• Tetanus

• Diphtheria

• Pertussis (whooping cough)

• Varicella - must submit evidence of disease or immunity

• Measles

• Mumps

• Rubella

• Hepatitis B and post-immunization serological titre to confirm immunity 

You should also have evidence that you do not have active Tuberculosis - (TST test & result & possibly a radiograph to confirm no active disease).

For staff and faculty, it is recommended that we have up-to-date and accurate immunization records in your personnel file. All immunization records are held in confidence by our registered nurse.

• First (and always) as soon as you are no longer working intraorally on your patient, have them re-don the mask they came with. Then you (if no AGP has been done) or your instructor or the circulator will escort the patient to the closest washroom in the clinic. The escort will wait outside the washroom for the patient and escort them back to the operatory.

• When you are escorting a patient around the OHC, do not cross alcoves. Instead, head to the inside back hallway by the student lockers to travel north and south in the clinic.

If your patient has mobility issues, retrieve a wheelchair from an alcove to help them move around the 8th floor. You (or an instructor or circulator) can use the wheelchair to move mobility-challenged patients for things like:

• Take a patient to the washroom

• Bring a patient into the clinic from patient services

• Take a patient out to the patient services

• Take a patient to Oral Surgery

• Take a patient to the shade room

• Take a patient to radiology

    **Remember that the wheelchair must be disinfected before returning it to the alcoves**

Staff, students and faculty are our greatest asset. We’ve created our IPC & PPE policies to not only protect our patients but to protect our people as well. Removing your scrubs and head cover after a day (or clinic session) of patient care helps to prevent cross-contamination of your items, like your coat and your backpack and it helps to prevent you from carrying contamination from work/school home to your family. We are trying to help you develop career-long IPC & safety habits that help to protect our patients, you and your families. 

Remember, not everyone who is leaving KEC is going home. They may be going to another space on campus and should have their lab coat over top of their scrubs when doing so. If you have concerns with a particular person's IPC, take the time to privately and respectfully speak to that individual to address the concern. We must function as a team to ensure everyone's safety.

As the temperatures drop outside the temperature readings taken during our fit-for-work screening have been extremely unreliable. We have continued taking temperatures, even though the rest of Alberta Health Services (AHS) has stopped taking temperatures for their staff and patients, to comply with the joint guideline of ADA&C, CRDHA and CADA (dated August 2020).

In consultation with those involved in developing the guidelines, they are leaving the decision regarding temperatures to our discretion. Therefore, we will stop taking temperatures as part of our screening process starting Monday, Nov. 2.  In doing so, we are in line with current scientific evidence and AHS’s screening process.  

One rationale for removing temperature checks is that fever in general is not a reliable sign of COVID-19 infection. Evidence shows that with core body temperature measurements, not the less reliable non-contact temperature measurements we have been doing, there is a COVID-19 detection sensitivity of 24% at most. Read the article here.

Patients’ temperatures will continue to be monitored in the clinics as these measurements are taken as part of a comprehensive set of vital signs and aren't used solely for screening purposes. The measurement we take on patients using non-contact thermometers is far more reliable because by the time we measure their temperatures in  the OHC clinic, the patient's surface temperatures should have returned to near normal after coming in from outside.