On May 28, 2020 the College cohosted a town hall with the Association of Dental Technologists of Ontario (ADTO) to present several facets of COVID-19 and the impacts for RDTs, patients, the public and other health care providers. One of the main topics of discussion was the Return to Practice Guidance for RDTs, published on May 22, 2020 and revised on June 4, 2020. There was an opportunity at the end of the town hall for RDTs to ask questions about this guidance and many valuable questions were asked. Since then we have received many more through e-mail and the ADTO. These questions have been compiled and can be reviewed below.
Q: How can we screen patients when they arrive at the workplace?
A: Contact/droplet precautions for the individuals who conduct patient screening (screeners) should be in place. Screeners should ideally be behind a plexiglass barrier to protect from contact/droplet spread. If one is not available, screeners should maintain a physical distance of two metres distance from the patient. Screeners who do not have a barrier and cannot maintain a physical distance should use alternate contact/droplet precautions which include the following PPE: gloves, isolation gown, a surgical/procedure mask, and eye protection (goggles or face shield).
RDTs should use the latest COVID-19 Patient Screening Guidance Document on the Ministry of Health’s COVID-19 website, which may be adapted as needed and appropriate for screening purposes.
Q: If RDTs leave their workplace to visit a dental clinic, should they change their clothing upon return?
A: Protective clothing (e.g., gowns, lab-coats, workplace footwear) should not be worn outside the workplace. They should be changed out of before leaving the workplace (e.g., visiting a dental clinic) and clean protective clothing changed into upon returning. Protective clothing should be changed at least daily, and if it becomes visibly soiled or significantly contaminated by potentially infectious fluids or materials.
Q: If one of our employees get sick does the entireworkplace have to shut down for 14 days?
A: If an individual (e.g., staff, patient, visitors) who was in the workplace later tests positive for COVID-19, RDTs should contact their local public health unit for advice on their potential exposure and implications for continuation of work. The Ministry of Health also has guidance for COVID-19 testing and return to work (clearance) for health care workers.
Q: Many people work within two metres in a dental laboratory. If this physical distancecannot be met, what alternate measures are sufficient?
A: Where a physical distance of two metres cannot be met, alternate measures include staggering shift times, limiting the number of individuals present at one time, and using ground markings and barriers to manage traffic flow. If physical distancing cannot be maintained or if a proper physical barrier (e.g., plexiglass) is not in place, appropriate PPE must always be used. The College’s Return to Practice Guidance for RDTs lists the required PPE by settings in the workplace (refer to Table 1).
Q: Can RDTs wear a non-medical mask (e.g., cloth covering) as an alternative to procedure/surgical mask?
A: The College does not recommend that RDTs use non–medical (e.g., a homemade cloth mask) masks as an alternative to procedure/surgical masks. Non-medical masks may not provide protection from fluids or may not filter particles needed to protect against pathogens, such as viruses. They are not considered PPE.
Q: What is the difference between surgical masks and N95 masks?
Surgical masks and N95 masks are both PPE but differ in several aspects. Surgical masks are loose-fitting devices that create a physical barrier between the mouth and nose of the user and the immediate environment. They provide the user with protection against large droplets, splashes, or sprays of bodily or other hazardous fluids. They do not provide a reliable level of protection from inhalation of airborne pathogens, such as viruses or aerosol-generating procedures.
N95 masks tightly fit the face and filter airborne particles to protect the user. They provide a higher level of protection against viruses and bacteria when properly fit-tested.
For more information, visit the infographic from Centers for Disease Control and Prevention (CDC) and National Institute for Occupational Safety and Health (NIOSH): Understanding the difference between surgical masks and N95 masks.
Q: Do N95 masks (or equivalent as per Health Canada) require fit testing?
A: Yes, N95 masks require fit testing. Fit testing confirms that the mask forms a tight seal on the user’s face. When a mask does not fit properly, a portion of the air can bypass the mask’s filter and enter the breathing airstream through breaks in the seal of the mask along the user’s face. If this happens, they may be exposed to harmful pathogens in the environment.
Each staff member who is required to wear an N95 mask must be fit tested for each brand or model, unless the manufacturer indicates otherwise.
Q: Where can RDTs get training on N95 fit testing?
A: Some manufacturers or companies provide fit testing such as Dental Practice Safety, Levitt Safety, EK Gillin & Associates Inc., Hot Zone Fit Testing, Martech Group, Enviro EH&S Consulting Inc., and Partner Safety. In addition, the occupational health department at the local hospital may provide fit testing sessions.
Q: Can manually enhanced/improved surgical masks (e.g., by adding wires and clips) be used as an alternative to N95 masks?
A: The only masks that can be used as an alternative to N95 masks are ones that have been approved by Health Canada.
Q: If a workplace cannot acquire N95 masks for aerosol–generating procedures how should they proceed?
A: According to the Chief Medical Officer of Health (CMOH) an N95 mask is not required for all aerosol-generating procedures. As specified in the Return to Practice Guidance,
- wearing an N95 mask is required if aerosols will be generated on prostheses, devices or items that have had direct contact with patients who have screened or tested positive for COVID-19.
- wearing an N95 mask is optional if aerosols will be generated on prostheses, devices or items that have had direct contact with patients who have screened or tested negative for COVID-19.
- wearing an N95 mask may not be required where generated aerosols are contained and there is no exposure (e.g., isolated or fully sealed containment box).
Cases where these guidelines cannot be met must be referred to another practitioner. Where N95 masks are optional, RDTs must use their professional judgement to consider the risks. For example, an individual who is in a high-risk group (e.g., has an underlying health condition) may choose to refer the aerosol-generating procedures to another practitioner when there is exposure to aerosols.
Q: How long should the cleaning and disinfecting of the space be delayed if aerosols will be generated on prostheses, devices, or items that have had direct contact with patients who have screened or tested positive for COVID-19?
A: A sufficient delay time between the aerosol-generating procedures and cleaning and disinfecting of the space is required to allow for 99.9% dilution of an aerosol (i.e., removal or settling of contaminated or potentially contaminated aerosols). During this time, the space where the aerosol-generating procedures takes place must be untouched and vacated with the doors closed if a sealed containment box has not been used. If a sealed containment box has been used, leave the containment box untouched for the delay time.
The delay time can be calculated based on Air Changes per Hour (ACH). If the ACH is not known, the cleaning and disinfecting of the space should be delayed for a minimum of three hours. If the ACH is known or calculated by a Heating Ventilation and Air Conditioning (HVAC) professional, the delay time may be found in the table below.
Adapted from Guidelines for Environmental Infection Control in Health-Care Facilities, 2003, Centers for Disease Control and Prevention (CDC). https://www.cdc.gov/infectioncontrol/guidelines/environmental/appendix/air.html
If a containment box with suction is used, the delay time to clean and disinfect the containment box and other exposed areas may be reduced compared to a containment box without suction. The reduced delay time needs to be determined based on ACH.
Q: Why doesn’t the CDTO restrict RDTs from seeing patients?
A: Patients should be able to access the health services an RDT is trained to provide. When it comes to in-person care regardless of the workplace, the College relies on RDTs to use their professional judgement to assess both the risks and the benefits to the patient and themselves.
Where the College restricts the RDT from seeing patients is when they cannot meet the requirements of the College (i.e., Standards and Advisories, and Return to Practice Guidance) and the MOH’s COVID-19 Operational Requirements: Health Sector Restart. In this case, RDTs are asked to refer to another practitioner where possible.
Q: Does the College recommend that RDTs get tested for COVID-19 before returning to work?
A: The College recommends that RDTs get tested if they are concerned that they may have been exposed to COVID-19 or are experiencing any of the symptoms. There are assessment centres located throughout the province that conduct the test.
Given an incubation period of up to 14 days, a negative test result in a person without symptoms should not be used to rule out COVID-19. There is also a chance that the person was not infected at the time the sample was collected and has contracted COVID-19 since the date of the testing.