IPC Update

Feb. 3, 2022 | Health, Safety & Environment Coordinator

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Dear Staff, Faculty and Students,

Over the  past few days, we have received multiple queries regarding some important IPC issues. We thought it would be useful to share the answers to these questions with everyone.

As the pandemic has worn on, we have had several different sets of guidelines that are continually being updated and changed. With the rapidly moving Omicron variant, it has been a challenge to keep up with all the changes. Here is the most recent guidance that we must follow.

COVID-19 Quarantine & Isolation Requirements

Quarantine

After a close contact or lab exposure, quarantine is no longer required if you are fully vaccinated and asymptomatic. AHS has changed their guidance around what they are accepting as “fully vaccinated” for community based healthcare workers. Fully vaccinated, for the time being, is at a minimum, 2 doses of a Health Canada approved vaccine with or without a booster dose. 

Isolation

The length of isolation required after testing positive for COVID-19 varies depending on the individual's situation. The standard isolation time throughout the pandemic has been 10 days and recently we have had a start/stop with a 5+5 day isolation requirement. 

We are changing back to the 5+5 isolation requirement for healthy, fully immunized people. .Here are the details:

• People who are healthy, are not immunocompromised and have been fully vaccinated (see above for definition) may be eligible to return to in-person activities after completing Step 1 of the 5+5 day isolation requirement. 

  • Part 1 of 5+5 Isolation. You may begin Part 2 of isolation if the following conditions are met:

    • You are either asymptomatic or, you no longer have severe symptoms and your symptoms are intermittent and improving, or you are and have always been asymptomatic

    • You do not have a fever (>37.9℃) and have not had a fever in the past 24 hours without taking any fever reducing medications for 24 hours before starting 

  • Part 2 of 5+5 Isolation. If you have completed at least 5 days of isolation at home and all of the above conditions have been met, then begin Part 2 of isolation:

    • Submit a FFW screening form indicating you have completed Part 1 of your isolation requirements and you feel well enough to participate in person.

    • Wear a mask continuously when around others, at work and in the community. 

    • Attend only scheduled In-person work/learning activities on campus while in Part 2 of Isolation.

    • While you are on campus during Stage 2 of isolation, if you must remove your mask to eat or drink, ensure you are completely away (>2 meters) from everyone else. You must also take care to disinfect any surfaces you touched while you were eating/drinking.

    • Do not attend any campus or community events while on Part 2 of Isolation

  • After a minimum of 5 days of isolation at home AND 5 days of continuous mask wear, you can return to campus as usual if you meet the following requirements:

    • You do not have a fever (>37.9℃) and have not had a fever in the past 24 hours without taking any fever reducing medications for 24 hours before ending Part 2 of Isolation

    • You no longer have any other symptoms OR you have lingering symptoms that are continuing to improve and have become intermittent

    • You did not experience any new or worsening symptoms during Part 2 of Isolation - contact the IPC Team immediately if this happens

    • *Please note - you do not have to be completely symptom free to return to campus during Part 2 Isolation as long as your condition is improving and you are feeling well enough to be on site.

• People with a diagnosed illness that compromises their immune system are more prone to serious disease and require a longer virus clearance interval. For this reason, anyone who is known to be immunocompromised will be required to isolate for 14 days

Aerosol Generating Procedures (AGP’s) and Required Safety Measures

During recent clinic observations it was noted that many people have not been utilizing all of the required personnel, equipment and PPE when performing AGP’s. The IPC Team & OHC management worked very hard to complete testing and analysis of our clinical spaces during AGPs to ensure the safety of performing AGP’s with specific safety measures during the pandemic. 

The evidence produced from this analysis and others indicates that performing dental AGP’s during the pandemic has low risks to anyone in the clinical space provided all of the following safety procedures are performed.

Patients are pre-screened when confirming their appointment to ensure they do not have any signs or symptoms of influenza-like-illnesses and know not to come to campus if they may be sick

1. Patients are double screened upon arrival in KEC, first  on the main floor by AHS staff and then again more thoroughly, by the clinician, once seated in the dental chair

2. Patients are instructed to have their mask on whenever intraoral care is not happening

3. Operator &/or chairside assistant are utilizing full PPE

4. Both HVE & LVE are positioned intraorally directly adjacent to the sextant being worked on for the entire time aerosols are being generated

Deciding to perform a procedure that utilizes aerosol producing instruments such as high speed handpiece (HSH), low speed handpiece (LSH), cavitron or piezo OR the air-water syringe is NOT dependent on the patient's COVID-19 immunization status. We should be providing treatment options based on the patient's wishes and their current health & dental status, not based on if they are vaccinated or not. We need to be cautious to protect our patients' right to make autonomous health decisions and to provide them with the best care possible based on their individual health & choices.

If you are using any powered instrumentation such as HSH, LSH, ultrasonic scalers OR the air-water syringe you must first ensure the following safety measures are in place. NEVER perform an AGP without first taking proper precautions.

1. Where possible, have a co-learner / chairside assistant to manage the HVE & LVE. The patient can have control of the LVE but it must be in the patients mouth at all times during aerosol production

2. If you do not have a co-learner or chairside assistant you may utilize the Purevac HVE System, or the Dry Shield HVE System to ensure you have adequate control of any aerosols produced during patient care.

3. Both the operator and co-learner must be in full PPE - head cover, gown, level 3 procedure mask, full face shield and gloves for the entire AGP appointment

4. Do not leave the operatory during or after performing an AGP without removing soiled gown & gloves and cleaning your hands. It is preferable to utilize a third person who is not involved in the AGP to retrieve any additional items you may need during the appointment.

Mandatory Continuous Eye Protection, Mask wear and Fit for Work Screening

Kaye Edmonton Clinic site administration has informed us that because KEC is part of the University of Alberta Hospital Complex, we are required to follow enhanced IPC rules. 

• Continuous masking the entire time you are in Kaye Edmonton Clinic. 

• Continuous eye protection. AT ALL TIMES while in KEC. You MUST have either safety glasses or a face shield in place the entire time you are on site. DO NOT raise or remove your shield to uncover your face unless you immediately put safety glasses on. If you wear regular prescription eyewear, you must have safety glasses that go over your prescription glasses should you wish to raise or remove your faceshield in KEC

• Fit for Work screening mandatory. The date indicated above your green check mark on your form submission will be scrutinized upon your arrival by both AHS & SoD screening staff. You must load a new form each time you complete a FFW. Do not “clear” a previously used form to submit again as your dates & times of submission will not be recorded

**Failure to follow the above IPC standards is an IPC Infraction and may result in significant consequences**

Have IPC Questions, Concerns or Positive Comments? Email dentIPC@ualberta.ca.

Sincerely,
Dr. Khaled Altabtbaei, IPC Officer
Ronna Richardson-Lozano, IPC Coordinator