Infection prevention expert Jackie Dorst, RDH, BS, is back on the Orthodontic Products podcast to talk to host Alison Werner about the end of the COVID-19 public health emergency and what is means for the orthodontic practice.
The COVID-19 public health emergency, issued on January 31, 2020, by the U.S. government put in place temporary measures to increase the federal government’s ability to detect and contain the virus. On May 11, 2023, the U.S. Department of Health and Human Services allowed the public health emergency to expire. This will bring an end to a number of programs, including those that gave access to free vaccines and treatment for COVID infections. But, as Dorst explains in this episode, the sunsetting of the CDC’s COVID data tracking efforts will have the most impact on the healthcare sector. As Dorst explains, that data provided information on community infectivity which could be used to guide the sector’s infection control protocols.
In this episode, Dorst breaks down what the end of the public health emergency means for orthodontic practices and her recommendations going forward. She points to the end of staff and patient health screenings for COVID, but reminds practices that basic health screening is still important to protect staff and other patients from other infections. Dorst also talks about the importance of having a return to work policy for staff members who are ill, whether it’s COVID or not and the role masking can still play in the practice beyond those procedures that result in splatters and splashes. And from there, Dorst reminds listeners that OSHA’s respiratory protection standard, which predates the COVID-19 pandemic, and vaccine guidelines are unaffected by the end of the public health emergency. She talks about best practices and shares resources for practices.
To close out the episode on the public health emergency, Dorst addresses the CDC’s recent announcement regarding ventilation in buildings and public spaces. And while it doesn’t pertain to healthcare spaces, she reminds listeners of the CDC guidance for healthcare spaces, including orthodontic offices. OP
Resources mentioned in this episode:
Immunize.org—Healthcare Personnel Vaccination Recommendations
It’s great to be back, Alison and we were both just just together at the AAO in Chicago, which was a much more open meeting than the previous one in Miami Beach, especially in the reflection of infection control, wasn’t it? Yeah, and everybody was out and about. A few masks on attendees and but not nearly what we saw.
The year before, So it was an exceptional meeting and great to return with all that energy and interaction between the attendees. Yeah, yes.
Well, with the public health emergency ending, it’s going to affect the funding for a lot of programs that were allowed with that public health emergency, such as free vaccines and free treatments for COVID infections.
That will go away. So a lot of it is going to be policies and what can be paid for by the government, but one of the the things that’s going to affect us in healthcare and our infection control protocols is a lack of data.
During the pandemic, you know, we often would refer to what is the infectivity in your community and you would go to the COVID tracker website on the CDC website and see are you in a high level of infectivity and then that dictated certain airborne disease protocols.
With wearing N 95 respirators or not and then as the infectivity subsided then you could go back to normal PPE with it those web bases that that information is no longer being supplied to CDC by the health departments.
And CDC has even discontinued that COVID tracker website. So we don’t have that map to go to anymore. And even John Hopkins, that was another database that I went to. John Hopkins has discontinued their COVID dashboard as they called it. So we’re in the United States, we’re sort of in a a Gray area that we don’t know what the transmission is in our communities.
And that’s one of the challenges of going forward. You we hear a lot of talk about what are the lessons learned from COVID and that’s one of the public health lessons that we’ve learned is that we do need a better way of tracking infectious diseases and then disseminating that information to the communities. So right now that’s one of the significant changes for the orthodontic offices is that that has that data has gone away. Now there’s still recordkeeping on the number of deaths.
From COVID and we know the number of people that are hospitalized with COVID. There are currently 22,000 people a day that are still hospitalized with COVID across the nation. So COVID hasn’t gone away, but you’re going to see more and more in the future that we’ll talk about respiratory disease transmission, including influenza, the common cold RSV.
And still COVID it’ll be under that umbrella with it. So that’ll be some of the changes going forward. Well, several changes there. All of the screening that we did for employees and patients remember when we were taking temperatures and we were asking about symptoms with it. Well that screening specifically for COVID is going away however from many years pre pandemic even.
We should have been screening our patients and infectious patients, patients that are sick, we should be rescheduling them because we’ve all learned that if you’re sick, whether you’re an employee or the patient, stay home.
Don’t bring that infection into the office to spread to other patients and to spread to the staff. So screening is still important. And I would go back, I know in one of our previous in the sterilization room episodes, we even put together a little poster, if you will, that had emoticons on it talking about, you know, do you have a fever, do you have a cough, oh you know, or as the commercial goes that diarrhea with it.
Then please let us know and reschedule your appointment. So it’s going to be screening for any illness symptoms and temperature checks. Well, we learned from COVID that wasn’t a true indicator for COVID with it, but obviously if anybody has a fever, they’re infectious with something and they should stay at home. And the rule for how long you should stay at home before you return to work is 24 hours.
Without a fever, without taking fever, reducing medicines and symptoms subside. So having that return to work policy and that’s a good standard to go by is what’s going to be hours going forward. So that screening has changed and then another significant change is the universal masking.
Or what we refer to as universal source control. Everybody in the orthodontic practice during COVID wore a mask, patients wore masks sitting in the reception room. Anyone that came in with a patient, staff wore a mask except when they were in the staff lounge eating lunch. Well now as we’ve exited the pandemic, if you will and we’re coming into our new normal, if you know it, you will go back to more what was pre pandemic masking.
In the office. But again, if somebody comes in sick, if a mom comes in and she’s coughing and sneezing with her child, it would be appropriate to ask them to wear a mask while sitting in the reception room to keep from spreading any respiratory illnesses.
Well, staff masking is again going back to pre pandemic that we’ll always wear a mask when we’re doing direct patient care and with those splatters and splashes and it would be a regular surgical or procedure mask, a level 2 or a level three. However, you know we’re still going to keep those N 95 respirators that we learn to use because the difference between the N 95 and a procedure mask is that it fits so closely around the face and the nose. So it prevents.
Any air leakage in the gaps around a regular procedure mask and all of the breath that goes out and comes in with an N95 respirator on is filtered through the filter membrane. So if if we do have to provide patient care to someone who’s sick.
You would want to have an N95 respirator. If you have really high infectivity of influenza in your area, it might be that the team decides they want to wear an N95 respirator and we should. The the employer with OSHA states that the employee should have appropriate PPE to protect them. Now consider the instance that you have maybe an orthodontic assistant who’s had breast cancer.
And they’ve had surgery and are going through chemotherapy. That person is going to be very immune compromised and they’re going to need the additional protection with their compromised immune system of wearing an N95 mask with every patient treatment during that. While they’re they’re going through the chemotherapy. So and it may not even be that employee, it might be that they have a family member at home.
That’s immune compromised and they wouldn’t want to take the the disease home to them. So we’re still going to keep in 95 respirators around and OSHA under there in total respiratory protection. Now that includes that’s the OSHA had a respiratory protection standard for over 50 years. You know but it’s not COVID that it’s focused on, it’s on dust and chemicals and particulates that are in the air and that.
I N 95 respirator and even full face respirators or half face respirators. OSHA has a long history with that. So all of the employee training about how to dawn, how to doff, how to put it on and remove it and not cross contaminate to yourself, how to do a seal test where you blow out to see if you’ve got a complete seal and then inhale to see if the mask slightly collapses are going to be standard.
Training that is required for all employees and then you’re going to need to do a fit test and have documentation that that employee has passed a fit test for the particular in 95 respirators.
That you have in your office and that’ll be an annual update. You have to review that once a year and fortunately we can now do fit test in our orthodontic practices. We don’t have to go to a medical facility or have somebody come in and fit test kits are readily available. So it’s a pretty easy procedure to do to do your own inoffice fit testing.
Well, you know, I’m going to go back to vaccinations with it. Under OSHA, we’re all familiar that we should have our hepatitis B vaccination and the employer requires.
Or in the employers required to have documentation of that. So we had a lot of information about the COVID vaccine. But going forward, you should review and make sure if you’ve hired new employees, do you have the documentation that they’ve had their hepatitis B vaccination or and if not, do you have that declining statement And there are other vaccines that all healthcare workers should be taking and I’d like to share with the listeners.
There’s a website, immunize.org org that has the latest update information for vaccinations for healthcare workers, information about the Hepatitis B vaccination and all of the hepatitis viruses and why all healthcare workers should be vaccinated with it. And I always have my offices update their OSHA manual by downloading these documents with it. So the vaccine vaccinations that are recommended for all healthcare workers are.
The COVID-19, whatever is the current update on that, you know do you need a booster or not Hepatitis B vaccination, influenza as we come into the fall and get into October through April is the high respiratory disease transmission then that’s where we’re at risk of influenza, the common cold RSV.
Any of those airborne disease transmission And then next is MMR, the measles, mumps and rubella vaccination, especially for orthodontic practices because they’re dealing with young patients with children and we have a gap in vaccinations now because of all of this vaccine as it can see their children that don’t have their MMR vaccinations and varicella is the next on there. And then finally a Tdap vaccination, tetanus diphtheria.
And pertussis, all diseases that could be transmitted in the air, potentially we should have that updated vaccine vaccination on it. So getting back to our new normal, make certain that as healthcare providers, you’re vaccinated and up to date.
Oh, Alison, thank you for bringing that up. It is that announcement by CDC is a recommendation again and it was for public spaces, not healthcare spaces, not the orthodontic practice. So this is looking at maybe shopping malls, schools.
Buses, trains, airplanes, and the lessons that we’ve learned about airborne disease transmission, this recommendation from CDC now is not just directed at COVID, but it’s about having healthy air to breathe in buildings. And so they’re they’re recommending 5 air changes per hour. That means that all of the air in the room is circulated through the heating and air conditioning system, that it will be changed five times per hour.
And then that the filter that is in your heating and air conditioning system is at least of a filtration of a MERV 13. Now a MERV 13 means that that’s the the amount of filtering it will do will filter out 50% of the .3 Micron size particles. And these are routinely available at home repair stores you know the the big box stores and everything and and you can purchase them online and that they should be changed in a regular basis.
It does talk about implementing upper room UVC ultraviolet germicidal irradiation and using that as an additional or an adjunct.
However, that’s not like you’re hearing about UV irradiation In a freestanding HEPA unit that you would buy and put in your home or or in some other public area. This is installed up next to the ceiling. It is because ultraviolet irradiation can cause serious eye damage and blindness. It has to be installed and in a safe manner.
That it doesn’t cause harm. So we’re going to see a lot more information about this in the future. I think it’s more research is done. But this again was for public spaces. It did not change the guidance which is going forward and recommended by CDC for healthcare spaces. At healthcare in your orthodontic practice, your heating and air conditioning system should provide at least six air changes per hour. You should have that MERV 13 filter installed.
And again, routinely change it on a basis and I can’t give you a standard of change it once a month or change it every two months. It’s going to depend on the occupancy of your building, how many days a week are you open, how many people. It’s going to be different for an orthodontic practice that sees 40 patients a day versus one that sees 120 patients a day.
And has all of those people coming through. So you you have to judge what is going to be effective for you. And then fresh air coming into the building, that’s another thing that was in the public spaces that CDC specifically recommended that you have as much fresh air as possible coming into the building. And the indirect way to measure that is look at the amount of carbon dioxide in a space when we breathe in.
Then our lungs remove the oxygen from the air and we exhale carbon dioxide. The more people that are in a room breathing out, the higher the number of carbon dioxide. Outdoor air is 400 parts per million, so that we know is safe. That’s the best outside.
CDC’s recommendation from the studies that we’ve had show that if you get under 800 parts per million CO2 that you’re really going to have safe air and you’re not going to be at that high risk of an airborne infectious disease with it. So having a CO2 monitor would be a good idea in an orthodontic practice, especially in the public places.
And then I would recommend to orthodontic offices, look at your HVE, your high volume evacuation. That was one of the other things that we learned during the pandemic is that that high volume evacuation should be operating efficiently, that we should be cleaning our suction and so we don’t have wimpy suction.
And you can check the flow by having one of your service checks have a flow meter attached to your high volume evacuation and it should provide at least 300 liters per minute of evacuation on there. So I think we’ve pretty much covered all of the changes and how they affect the orthodontic office. You know, there’s one more thing though that I’d like to add and I still get a few questions about it.
Remember at the beginning of the pandemic when we did those preprocedural mouth rinses and there was a shortage of hydrogen peroxide and paroxyl and and people were talking about iodine and what kind of iodine. And it was recommended that povidone iodine or or hydrogen peroxide half a percentage and you rinsed and swished for one minute would kill the SARS cov two virus.
Well, researchers sown that wasn’t always true. It didn’t provide that much more protection. So on the CDC web page, CDC now says that this is not going to prevent SARS Code 2 transmission. However, if you want to use an antimicrobial mouth rinse, it is a good adjunct to your infection control program because any mouth rinse is going to reduce the bacteria.
The virus and any fungus or yeast that are in the patient’s mouth, and I’ve had orthodontist tell me that, wow, they saw such clean mouths during the pandemic where they were doing these mouth rinses that they’re going to continue going forward because they felt like, you know, it really enhanced their infection control and it improved their care that they could deliver to patients. So a positive thing that came out of the pandemic.
Oh, thank you Alison. Orthodontic Products does a great service in sharing all of the latest information for orthodontic team members.