Dr. Carter: Today, we're with Kathy Eklund, a member of the advisory board of Practice Update Clinical Dentistry Channel. Our topic for today is infection prevention and control in the era of COVID-19. The November 2020 issue of JADA published the first large scale report of data surveilling rates of COVID-19 infections and simultaneous infection prevention and control policies among US dentists. It was reassuring to note that the weighted prevalence of COVID-19 among practicing US dentists was 0.9%. But interestingly, only 12% of the respondents in the study employed pre-procedural mouth rinses for patients. Why do you think this percentage is so low?
Kathy Eklund: There may be several contributing factors to that. One, because the survey was conducted in June, there were many dental offices that weren't really back to full services at that point, so it could be that they answered something because they weren't really open. In terms of the CDC guidance regarding pre-procedural mouth rinses, the interim guidance suggests that there wasn't solid evidence available that pre-procedural mouth rinsing would necessarily be effective to reduce SARS-CoV-2, primarily because the studies just had not really been done. The ones that were there were very limited. But CDC did say, however, that if, in fact, you want to use an antimicrobial mouth rinse, there's nothing wrong with that, and it may reduce the number of organisms present, but not necessarily solid evidence that it would prevent disease transmission.
Dr. Carter: Thank you. I appreciate your insight on that. Please discuss with us some of the strategies that dentists and dental hygienists can use to reduce aerosols during the provision of dental care.
Kathy Eklund: CDC guidance is pretty clear in the interim guidances across the summer and last updated August 28th, that practices should avoid aerosol-generating procedures wherever possible. That would include using hand instruments instead of a slow speed handpiece or an ultrasonic or air polishing: those should be avoided because they do produce aerosols. If there is a reason why an aerosol-generating procedure would need to be done, such as a restoration being conducted where there would be a need for a high speed handpiece, you actually should employ several avenues of control, those being four-handed dentistry, high volume evacuation, and ensuring that you reduce the amount of time that you would be providing aerosol-generating procedures. Also using a full mouth dental dam is another mechanism to reduce aerosols.
Dr. Carter: Thank you. Would you please remind us why respirators with exhalation valves are not recommended for source control.
Kathy Eklund: The respirators with exhalation valves aren't recommend for that and should not be used during any surgical procedures, as unfiltered exhaled air from the provider may compromise the sterile field. If only a respirator with an exhalation valve is present, CDC suggests that you may be able to control it by covering the valve, say with a face mask. However, you need to do that very carefully because you don't want to compromise the seal of the N95 respirator.
Dr. Carter: Thank you. And finally, as frustration with worrying about aerosols grows, we must remind ourselves that while we are tired of the virus, that virus has not grown tired of us. What suggestions do you have for dental practices to remain vigilant in our efforts to prevent healthcare-associated infections?
Kathy Eklund: There are several things to consider. I think you need very good administration and leadership to make sure that individuals are knowledgeable of what the guidance is. You need to have clear written policies and procedures and have onsite staff who manage and monitor the infection control program, and people need to work together because everyone really is in this state of COVID fatigue, and we can't let up our guard on this. Just speaking from the standpoint of dental hygiene, I've had hygienists contact me and say, "Do I need to change my N95 when I'm using the ultrasonic scaler?" And I'm like, "Why are you using the ultrasonic scaler? You should be avoiding aerosol-generating procedures."
Dr. Carter: Thank you.