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  • Writer's picturejedho.dmd

updated clinical protocols 6-2020

hello world!

been lazy and haven't written anything since.... 2019 😁

the new abnormal, has been a game changer to say the least. thousands have died, and thousands more will die. millions, if not billions will lose their jobs. but in light of this, the race for a vaccine is moving faster than any previous vaccine research in history. there is hope yet for the old normal.

the dental industry in particular is facing some challenges because of the unavoidable proximity we maintain to treat patients. nonetheless, we in the dental industry have already an aseptic practice in place even before this.

Here are some of the procedural changes as of the moment:

  1. As before, clinic hours are by appointment only. After agreeing on schedule and fees: For new patients, you will be given two online forms to fill up (patient data info, and COVID-19 risk assessment/triage). For existing patients, only the latter form is required. A Google Forms link will be sent you via sms/email/FB/Viber or whichever way you communicate to me. NO TRIAGE FORM RESPONSE, NO APPOINTMENT!

  2. Already existing patients are a priority. New patients have secondary priority.

  3. Upon entering the building (via the ground floor common lobby), your temperature will be taken by the guard, shoes/slippers asked to soak and scrub on their disinfection mat.

  4. Face mask fashion is in effect. As elsewhere in the city. Just wear it right, make sure nose and mouth is covered.

  5. Entering my clinic, you will be given alcohol for disinfecting hands. Or you can choose to wash with soap, whichever the patient would prefer.

  6. No chaperone policy. Only a minor below 18 years old will be allowed 1 guardian to accompany him/her.

  7. Before and after treatment, patient may be asked to gargle for a minute with mouthwash. After treatment, patient may wash their hands/face if preferred.

  8. Toilet business may be conducted at the common restroom located outside the clinic. I will keep my own toilet, personal for now.

  9. Contactless transaction via bank transfer/Paymaya is encouraged. But physical cash is still ok.

  10. Additional fees for some procedures due to the added expenses.

Here are some changes made in the clinic, and some new gear to deploy:

  1. Reduction of displayed items. Trying my best to declutter. 😃

  2. Manually inputting patient data on my digital record. (will copy data from submitted form responses) I'll also have to take a picture of you for the record.

  3. Spraying and wiping of Sodium Hypochlorite disinfectant on working areas. Spraying of Lysol disinfectant on non-working areas. (already doing this even before, but with added urgency now)

  4. Continued use of autoclave for sterilization, and liquid immersion solutions for disinfecting instruments prior to storage/next usage/sterilization.

  5. Usage of utility gloves for post-treatment sanitizing, washing.

  6. Bought an air purifier to help with the air circulation, to reduce aerosols, since the clinic is basically windowless, and not well ventilated.

  7. Prudent use of plastic barriers, or usage of aerosol box for aerosol generating procedures like prophylaxis or fillings. (Usage of aerosol box subject to site visibility during actual clinical operation.) I'd like to minimize use of single use plastics and analogues as much as possible. Surfaces that can easily be wiped clean will not be installed with additional plastic barriers.

  8. Usage of isolation gown for certain patients availing any services that are aerosol generating. (subject to my own comfort and risk assessment to perform the task)

  9. Usage of reusable respirators, full facepiece respirators (for aerosol generating procedures) - in the absence of trustworthy surgical masks, and inflated pricing since the Taal Volcano eruption. I haven't been able to restock trustworthy face masks since January 2020. (the brand i use is Medicom Defender, and not some shit-for-name Chinese unknown brand)

  10. Usage of face shields / eye protector - been using it for years

Lastly, here are some things you may see the other clinics are doing, but I won't be, with reasons explained below.

  1. Installation of soft/hard plastic sectional dividers - This will hamper the little airflow that exists in the clinic, as a result, aerosols will remain longer in the air. The added vertical surfaces are also added surface area for droplets to stick on, which any person can inadvertently touch when passing thru said dividers.

  2. Fogging/Misting - The DOH is NOT recommending these and i am not the smarter. The chemicals used (usually diluted Sodium Hypochlorite) may cause unexpected reaction in some people too.

  3. UV lamps - UV disinfection is designed for transparent objects like glassware or plastic that cannot undergo autoclave sterilization. They require a specific contact time for it to be effective, they also need to be moved from time to time so that 'most' nooks and crannies can be penetrated by the UV light. UV is also harmful to the operator.

  4. Isolation gown for the patient - unless you are undergoing general surgery, this is unnecessary waste of single use things! We already use a paper towel or absorbent bib placed on the patient. Besides, the splashes of aerosol are mostly water mixed with some of the patient's own fluids!

  5. Isolation shoe sock - another unnecessary waste of single use things! Unless you are in a pediatric dental clinic where you expect kids to fall on their knees or lick the floor or play on the floor, this is just waste. The human instinct is to wash whatever they drop on the floor.

  6. Extraoral suction - this is optional. But the key is to suck closer to the origin. (inside the mouth where the handpiece is used)

i hope this clears things up for some of my patients. hope to see you all soon i guess.

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