A new year. A new COVID-19 variant. In this episode of In the Sterilization Room with Jackie, infection prevention expert Jackie Dorst, RDH, BS, talks to Orthodontic Products Chief Editor Alison Werner about how orthodontic practices need to manage staff members with a SARS-CoV-2 infection or exposure as the omicron variant sweeps the nation. She breaks down the latest interim guidance from the CDC for healthcare personnel and explains what it means for orthodontic staff as they navigate COVID-19 exposures and infections and potential staff shortages.
Jackie also offers some advice on communicating with patients that your orthodontic practice is doing everything it can to keep them safe during their visits. And she provides a refresher on the seven basic infection control standard precautions your practice should have in place to protect both staff and patients from a COVID-19 exposure/infection. OP
– Hello, my name is Alison Werner, and I am the chief editor of Orthodontic Products. Thank you for joining us for today’s episode of “In the Sterilization Room with Jackie” where we talk to infection prevention expert Jackie Dorst about what you need to know to keep the orthodontic team and patients safe during the COVID-19 pandemic and beyond. For over 30 years, Jackie has been a consultant specializing in instrument sterilization and infection control and prevention in the dental setting. She has degrees in microbiology and dental hygiene and has been a featured speaker at the American Dental Association and the American Association of Orthodontists. Now we’ve been on a little bit of a hiatus, Jackie, but it’s good to see you again.
– Happy New Year.
– Happy New Year. And we’re now in January of 2022 and approaching the third year of the pandemic.
– I know. I know. I know.
– We’re coming up on our two-year anniversary of doing this podcast or this video series.
– So yeah, so today in the ongoing saga that is the COVID-19 pandemic, we’re gonna talk about the Omicron variation, or not variation. Variation? No. Variant. There we go. There’s the word I’m looking for. So hopefully, we’ll provide some clarification to orthodontic practices about how they should navigate this wave. So Jackie, how has the Omicron variant been affecting practices from what you’ve heard?
– Well, the first cases of the Omicron variant were identified in the United States December the 1st of 2021. And in four short weeks, it rapidly spread across the nation. Until by the first week in January, every state had a case. And even there were enough cases that it was putting hospitals into staffing shortages because of the increased number of patients and because so many of the staff members had acquired infections with this highly infectious variant that they didn’t have adequate staff to care for the patients that were arriving at hospitals. So Omicron is much more infectious. Estimated to be anywhere from 1 1/2 to three times as infectious as the ancestral virus and of the Delta virus with it. And people seem to get sick much more quickly. The virus replicates quickly and with large numbers. It’s replicating, the Omicron variant is replicating in the upper respiratory system around the thorax, the back of the throat, in the nose. And because of the large viral numbers, the load, if you will, then as people exhale, whether it’s talking, laughing, singing, breathing, that we’ve heard over the two years of the pandemic with it, they expel a lot more viruses than they did with the virus when it was replicating in the lungs. Originally, we learned that the virus, it liked the respiratory system. The viral particles would enter the cells that line the lungs and reproduce there, and then be expelled. So Omicron, as a variant, has changed so that it has become more infectious and is infecting more people. And it’s also avoiding the protection that vaccines are providing with us.
– Hmm, yeah, yeah.
– So we’re getting more breakthrough infections for people who have been vaccinated and people who were vaccinated as early in 2021 as the vaccines were introduced, then that vaccine, the protection was waning, which happens with many vaccines as after you get that high boost of antibodies right after you’re vaccinated, and then it levels out over time. And so then we’ve started using boosters, right? Six months after you’ve had your mRNA vaccine, then it’s now recommended that you have a booster to up those antibodies again and give you that greater protection with it. And Omicron is, as I said, it’s highly infectious. And it’s found ways to get around the protection provided by the boosters and even people who have acquired immunity from having had a previous infection with it. And one of the largest segments of our population now that doesn’t have that protection is children. And as children have started going back to school, we’ve seen an increased transmission of infections. So Omicron is affecting not only the orthodontic staff, but orthodontic patients that are coming in for treatment with it. And it’s been challenging because with the quarantine and isolation recommendations from CDC, staff members, I’ve had orthodontists calling me, saying, “Half of my clinical team is out on quarantine or isolation. And they’re gonna have to be out for 10 days to 14 days. Jackie, what are we supposed to be doing?”
– And CDC did change their guidance on December the 23rd because of the staffing shortages and looking at the science of the infections and how severe they were at the very beginning of the infection and did that highly infectious period subside a little more rapidly with the Omicron variant.
– Right. Well, let’s talk a little bit about that CDC guidance from December 23rd. Now the guidance is for all of healthcare professionals because the CDC is no longer separating out dental health providers. So how should the orthodontic practices interpret this guidance? ‘Cause it can be a little confusing.
– That’s right. It’s true, Alison. CDC removed the separate page for interim infection control guidance during the pandemic for dental offices, and then put an umbrella for all of healthcare. So not only dental, orthodontic, ambulatory surgery centers and hospitals now all come under the same guidance for protection for staff members and for patients during the pandemic. So it is confusing because, with the December 23rd guidance, it was shortened that staff members who were exposed didn’t have to quarantine or isolate, quarantine at home, after an exposure incident. That’s the correct term. You isolate if you’re infected and you quarantine if you’ve been exposed. They didn’t have to quarantine for that 10 to 14 days. Now, it was five days. But there was a little bit of confusion about how this applied because the guidance came out with a chart that listed three categories. And again, this is for all of healthcare workers. And the first category, the first column of the chart, was Conventional. So that is conventional strategies when you don’t have an increase of infections and a shortage of staff to care for patients.
– Now remember, CDC is looking at hospitals.
– So hospitals can have emergency patients that it may not even be COVID-related and they don’t have enough nurses, lab technicians, and physicians to care for all those patients. And we’ve been reading about staff, hospitals that are overwhelmed, and they’re having to call in the National Guard to help with it. And hospitals are even closing certain segments of their hospital. I know in Miami, one of the hospitals had to close their OB-GYN unit-
– Oh, okay.
– Where they couldn’t even deliver babies ’cause they didn’t have enough nurses and doctors.
– So that’s where they went. Then if you have a shortage of staff, they added a Contingency column-
– Mm, okay.
– And gave allowances for when could staff continue to work and when can you work if you had even tested positive but maybe didn’t have signs or symptoms. And then there is a third column, Crisis. So this is very similar to what we looked at with the guidance on PPE.
– Oh, yeah.
– Remember at the beginning of the pandemic where if you couldn’t get an N95 respirator, then what was your contingency?
– And if you couldn’t get any mask, what was your crisis with that?
– Right. Okay.
– And now that the PPE supplies have been resumed, we are now under Conventional categories. And that emergency use authorization, even to use KN95s, that’s been removed because we’re no longer in those contingency or crisis categories. So it’s really similar to where are you?
– Okay. Okay. So most orthodontic practices then are gonna be in that Conventional column.
– Correct. However, I’ve had a lot of confusing because doctors have been calling me, saying, “Half of my clinical team is out because they either have a child at home who has tested positive or has symptoms, and so they’re having to quarantine with that child because that’s a high-risk exposure incident, or they’ve tested positive. They may not even have symptoms.” So they said, “Okay, Jackie, with this new CDC guidance, does that mean that my staff members only have to be out for five days?” And I said, “Well, wait, we need to look closely at the chart. And when would you move your practice to the Contingency?”
– So looking at… You have to go to a whole separate webpage from CDC about when you would move to those Contingency column on it. And that would be only after you’ve had to cancel nonessential orthodontic appointments because you don’t have enough clinical assistants to see those patients.
– Mm, okay. Okay, so it’s down to staffing.
– It is. Do you have enough staff to care for your patients? So for example, are you canceling all of your new patient exams? That’s non-urgent at this time. Maybe an arch wire check or a retainer check, those that would not, that those appointments could be postponed and not affect patient care.
– And then the second category that CDC put in there, a qualifier, if you will, is, are you now moving administrative team members to the clinical area? Maybe you have a treatment coordinator who was formally an orthodontic chairside assistant. And is that treatment coordinator now seeing clinical patients because you don’t have enough patients or enough team members to treat patients?
– And yes, there are urgent patient appointments that you still need to see, such as if you have a patient that’s got a palatal expander in, that’s not something you would want to put off until the infections subside in your area.
– Are you in that period of high infectivity? So have you made those two adjustments, if you will, so you can continue providing patient care? And then the third thing I would say is, have you added in an extra day? Maybe you normally work three to four days a week.
– Are you now working five days a week in your orthodontic office so that you can see those extra patients with it?
– Mm, okay.
– So those changes, have you made those adaptations that would move you into the Contingency category?
– So yes, most offices would still now be in the Conventional column.
– And I think it’s important for us to review-
– What are the precautions now from CDC?
– Right ’cause even though-
– It’s confusing.
– It’s confusing. We talked about it earlier and I was confused.
– So yes, please break it down.
– So if you’re going up the chart on the screen from… And list the webpage so that the viewers could go to it for those who can see. And for those who can’t, if you’ll just go to the CDC, you want to look up the December 23rd guidance for it on there. And if we’re looking at work restrictions for healthcare providers who are infected, so that would be someone who tests positive or definitely has signs and symptoms of the disease, then if they’ve been boosted, vaccinated, or unvaccinated, so this is someone who’s infected, then they’re still under conventional strategies. They’re going to isolate at home for 10 days.
– [Alison] Okay.
– [Jackie] That hasn’t changed.
– [Alison] Okay.
– [Jackie] Or seven days. It can be shortened. If they have a negative test, then they could return to work after seven days.
– [Alison] Okay.
– [Jackie] If they’re asymptomatic or mildly symptomatic or with improving systems, then they can return after seven days.
– [Alison] Okay.
– [Jackie] So that’s conventional strategy with it-
– For someone who’s infected or has tested positive.
– Okay. So testing is key there to return.
– Mm-hmm. Yes.
– Now work restrictions for someone who’s asymptomatic and has had that high-risk exposure, being exposed to someone for more than 15 minutes without a mask on.
– So let’s take, for example, an orthodontic assistant whose child, whose second-grade child, has come home with an infection, has tested positive, definitely, that’s a high-risk exposure.
– So we’ll see that if you are boosted, vaccinated and boosted… Because remember, Omicron has learned to get around the vaccination that boosting gives you the higher antibodies that is helping to prevent those breakthrough infections.
– Right, yeah.
– So Omicron is causing breakthrough infections, even for ones who, people who are vaccinated or who have acquired immunity. So the conventional strategy, there is no work restrictions for someone who’s exposed. So the orthodontic assistant has child at home who’s infected. She can still continue to come to work if she tests negative on day two.
– [Alison] Okay, and this is for someone who’s boosted.
– [Jackie] This is for someone who is vaccinated and boosted, okay?
– And boosted, right, okay.
– [Jackie] And then she or he would still need to go for a second test on days five through seven.
– [Alison] Okay.
– So if the orthodontic assistant’s child comes home on Monday from school, has an infection, then on Wednesday, she can continue to work Monday and Tuesday-
– Tuesday, right.
– But if she’s fully boosted and get a test on Wednesday, if it comes back negative, she can continue to work, and then go for another test on Monday, the following Monday, so.
– Okay, okay, okay.
– So that’s fully boosted.
– Yeah. The second category under the conventional strategy is if the employee is vaccinated or unvaccinated-
– But not boosted.
– [Jackie] Not boosted or unvaccinated or has had a prior infection within the 90 days, meaning that’s acquired immunity-
– [Alison] Right.
– [Jackie] Then the conventional strategy is still going to be 10 days of isolation at home.
– [Alison] Mm-hmm.
– [Jackie] Excuse me, of quarantining at home or seven days with a negative test.
– Okay, okay. So no, they can’t come into work.
– Yeah, yeah.
– So I think a lot of the confusion came because this was a general guidance for hospitals, ambulatory surgery centers, dermatologist offices, and orthodontic offices.
– Yeah, yeah.
– And everybody was confused and they didn’t know the definition for conventional strategy, contingency, and crisis.
– Obviously, we wouldn’t have the crisis category in the orthodontic office.
– But you might go into a contingency category-
– If you had a high rate of infectivity in your community.
– And you had a number of team members that are out.
– So I think that will help them to follow this chart and determine the isolation or quarantine time.
– Okay. Well, so once they’ve got that sorted, what should practices be communicating to their patients then? What’s your advice?
– Oh, the patients are just as confused as we are-
– Yeah, I would definitely say that.
– In the orthodontic office.
– Because there’s been… It’s like the information changes daily.
– And you go, does this apply to me or does it not? And I’m gonna refer to Dr. Chuck Gulland in Pennsylvania. And it’s Gulland Orthodontics. And they came out with the best social media post on their Facebook page. And they had four pictures in there. And they showed disinfecting the chair and the form that they use for checking and asking about symptoms for patients, and then taking someone’s temperature, and then with their surgical mask and their face shield on. And you could still see the eyes smiling behind all the PPE.
– And what the message said was, “It seems like so long since we first heard the word COVID. We know everyone is wary of the rules, the regulations, the precautions, and the procedures. We are, too. But the health and safety of our patients, family, doctor, and staff are too important for us to let down our guard. We still perform a check-in for all appointments, check temperatures on our staff as well, disinfect common areas, the equipment, the doorknobs, and the counters. We require masks for everyone in the office. And of course, we wear our PPE. Is every business doing this? Maybe not, but we do. We appreciate your cooperation and understanding because #WereInThisTogether.”
– Ah, that’s nice.
– What a positive message to your patients. And giving your staff that high five, that pat on the back-
– We’ve gotten through this pandemic successfully. And we are going to continue to get to the end of the pandemic when the SARS-CoV-2 virus becomes endemic and not a pandemic.
– Right, exactly. Well, Jackie, just real quick, can you just run down the precautions, everything that the practices should have in place from masks down?
– We really need to adhere to those seven basic infection control standard precautions, if you will.
– But I think it’s really important at this time, just like Dr. Gulland’s Facebook page said, is for us to remember not to, to separate patients in the reception room, and not to overload them in the reception room. Continue to check on those symptoms and continue to do the pre-procedural mouth rinses to reduce the viral load. Make sure that you have that MERV 13 filter installed in your heating and air conditioning system. And make certain that your vacuum is working the most efficiently that when you use it, it can reduce those aerosols that are created should we use a high-speed handpiece. And whenever you’re doing aerosol-generating procedures, continue to wear an N95 respirator. Those are key elements to keeping us safe and keeping our patients safe.
– Exactly. Well, thank you so much, Jackie, for really unraveling this for all our viewers. And it’s great to see you again. It’s nice to be back for our viewers. And please check back soon for the next episode of “In the Sterilization Room with Jackie.” In the meantime, to catch up with past episodes or to check out the latest orthodontic industry news, visit our website at orthodonticproductsonline.com. Until next time, take care and stay safe. Thanks, Jackie.
– Thanks, Alison.