Safe office

TELEPHONE INTERVIEW

When scheduling a patient for a procedure, in addition to the standard general medical interview about the patient's health, we should conduct a preliminary epidemiological interview for COVID-19.

In accordance with the guidelines of the Supreme Medical Chamber and the Polish Dental Association, the following recommended interview should be conducted:

• Have you been in a risk country/region indicated by WHO and GIS? (list of countries available on gis.gov.pl)
• Have you had contact with people from at-risk areas?
• Have you had contact with people with CoViD19?
• Have you had contact with people quarantined?
• Have you had a fever, cough, runny nose, conjunctivitis or difficulty breathing/shortness of breath?

If the answer to at least one of the above questions is positive, you should:

1. Recommend contacting the local sanitary-epidemiological station in any doubtful situation.
2. Direct the patient to a 14-day home quarantine (at the registration stage it is possible to issue such a recommendation, taking into account the GIS procedures of February 14, 2020) [1].

Despite a negative interview, if you believe that the patient has worrying health symptoms (e.g. flu-like symptoms), it is worth postponing the visit for at least 14 days.

IMPORTANT:

We inform the patient about the new rules of admission introduced in the office due to the occurrence of COVID19. Additionally, we warn about the need to fill out an appropriate information questionnaire and ask that the patient come to the clinic without accompanying persons, if possible.

PLANNING A VISIT 

It is recommended to adopt a precise system for planning visits to medical offices:

1. People from the risk group, i.e. over 65 years of age, people with comorbidities (circulatory system diseases, hypertension, respiratory diseases, diabetes) – should be admitted, if possible, on the same day.
2. An appropriate time margin should be allowed between subsequent visits so that in the event of delays in the provision of services, patients do not have contact with each other and that the office can be properly disinfected (intervals of approx. 30 minutes are recommended).
3. Patients should not come with accompanying persons (if this is not possible, please ask for only one accompanying person and for them to remain outside the office).

According to GIS and PTS guidelines, each medical office should be equipped with:

• Surface-active disinfectants.
• Air disinfection devices – devices that operate when staff are present are recommended. This allows for continuous sterilization of the room even in the presence of “contaminating factors”, primarily people.
• Personal Protective Equipment (PPE) for the patient, staff and physician.
• The telephone numbers of the district sanitary and epidemiological station, the company performing sanitary transport of patients with suspected SARS CoV-2 coronavirus infection (list from the National Health Fund's District Sanitary and Epidemiological Station) and the infectious diseases or observation and infectious diseases ward should be placed in a visible place.

IMPORTANT

The number of items in the clinic should be limited to the necessary minimum. This will allow for easier disinfection of surfaces.

ENTRANCE ZONE 

It is recommended to designate appropriate patient reception zones in offices.

According to the guidelines, the patient should immediately disinfect their hands upon arrival and undergo a mandatory epidemiological check. For this purpose:

1. We provide the patient with PPE (gloves, cap, protective apron and shoe covers).
2. We measure temperature with a non-contact thermometer.

• Temperature below 37,3 degrees C – no flu-like symptoms – recommendation for a visit.
• Temperature above 37,3 degrees C but below 37,9 degrees C – with flu-like symptoms – at the discretion of the attending physician regarding the benefits of starting treatment and the consequences of postponing the visit.
• Temperature above 37,9 degrees C – forwarding information to the appropriate sanitary-epidemiological station, proceeding in accordance with their guidelines, transferring the patient to the care of an infectious disease unit.

1. We are sending you the SARS-CoV-2 pre-qualification survey to complete.
2. If the patient comes with a companion, we also subject them to the above-mentioned procedures.

In the event of doubtful interview or temperature measurement, it is recommended to postpone the visit for at least 14 days. 

It is recommended to maintain a distance of 1 metre (WHO recommendations from 27.02.2020/1/2) [6] to approximately 2 metres (XNUMX ft – feet) [XNUMX] between people in a room, queue, etc.

IMPORTANT

It is important to pay attention to the medication taken by the patient. Anti-inflammatory drugs can lower the temperature and thus falsify the measurement result.

CLEAN ZONE

A visit to a doctor’s office (in a so-called clean zone) should begin with the following arrangements:

• We inform the patient about the exact treatment plan
• We establish specific gestures and movements that allow for easy and clear communication with the patient during the procedure (verbal communication must be kept to a minimum).

Before starting the procedure, we put a protective pad on the patient. Then we ask the patient to take off the protective mask themselves (holding it by the straps) and put it in the pocket of the pad. In the case of procedures on the upper part of the face - the patient can remain in the protective mask.

IMPORTANT

Whenever possible, treatments such as make-up removal, skin disinfection, and post-treatment massage should be performed standing behind the patient.

The application of Personal Protective Equipment should take place in a designated place, other than the treatment room. The order is important here. It is very important to remove any jewelry that the doctor is wearing. Before starting to dress, hands should be disinfected.

Order of putting on PPE:

• Putting on a disposable gown (waterproof protective medical gown with long sleeves)
• Putting on a highly filtering mask (with appropriate approvals and certificates)
• Putting on a surgical mask (with appropriate approvals and certificates)
• Putting on safety goggles/glasses
• Putting on a disposable cap
• Putting on the visor (covering the jaw line)
• Putting on disposable gloves (standard gloves that should cover the wrist and cuffs of the gown)
• Putting on a second pair of gloves (this will protect your hands from the disinfectant when taking off the PPE)

Removing PPE requires special care, as infectious material may be present on the outer surface of any item worn. Remember to disinfect your hands after each piece removed.

PPE removal order:

• We take off the first pair of gloves (safely)
• We take off the apron (holding the back of the apron, pull it forward so that without touching the front part we can pull it off and roll it up inwards, while rolling the sleeves outwards).
• We take off the second pair of gloves
• We take off the goggles/visors (without touching their front part - place them in an appropriate container)
• We take off the first mask (holding the straps)
• We take off the disposable cap

If a second person (assistant, nurse) is involved in the treatment, he or she should also wear PPE (mask, gown, gloves) and follow the same recommendations as the doctor.

IMPORTANT

• Disposable equipment should be disposed of immediately after removal. to the infectious waste bin.
• Reusable equipment (goggles, face shield) should be placed in a container intended for contaminated medical equipment (these elements are later subjected to a decontamination process).
• Do not touch surfaces and objects with hands wearing gloves that were used during the procedure.
• Remember to decontaminate objects and surfaces you touch. In particular, avoid touching your face with your hands.
• Hand disinfection should apply to dry hands, never wet ones (due to the dilution of disinfectant fluids), and its time cannot be shorter than 30 seconds.

After the procedure, the office and all possible tools used during the visit should be disinfected appropriately. In particular, the following should be disinfected:

• Flat surfaces
• Computers, keyboards, mice (if there are any in the treatment room)
• Door handles, pulls, buttons

Keep reusable equipment and devices intended for cleaning in a contaminated waste container.

The room should be continuously sterilized or take breaks (30-60 minutes) and use open UV lamps.

IMPORTANT:

Disinfection should be carried out in the correct order. First, use disposable wipes soaked in disinfectant (so as not to raise the deposited aerosol), then spray the surfaces with a disinfectant solution and wipe (while wearing disposable gloves).

A 0,1% sodium hypochlorite solution should be used for 1 minute (maximum 1 part sodium hypochlorite to 9 parts water) [3].