COVID-19 Exposure Control Plan

At MacKenzie Dental Center, the safety and well-being of our patients and staff are of paramount importance. As we participate in Phase 2 of BC’s Restart Plan, we are committed to implementing multiple measures that ensure we protect everyone who enters and exits our clinic.

We continue to follow the guidelines and recommendations set forth by Provincial Health Officer, Dr. Bonnie Henry, the BC Center for Disease Control, the College of Dental Surgeons of BC, WorkSafe BC and the British Columbia Dental Association.

The model below, as illustrated by WorkSafeBC, represents the Hierarchy of Controls for COVID-19 management. We have used this as a guide in developing our new protocols. The diagram clearly shows that the first level of management (Elimination) has the largest influence while the last level (Personal Protective Equipment) has the smallest impact.

1. Elimination

The goal of this first level of protection is to eliminate any exposure to the SARS-CoV-2 virus. The following lists some of the measures that will help us with this:

• We will be screening all our patients (i) before they make their appointment, (ii) when we are confirming their appointment 24-48 hrs prior to their appointment and (iii) upon arrival for their appointment.
• We will be taking our patients’ temperature. If they present to the clinic with symptoms &/or have a fever, they will be provided with a mask, and directed to leave our premises immediately. They will be directed to wait outside until we can re-direct their care, eg., tele-consult, call 8-1-1, etc.
• We will be similarly screening and recording the temperature for all our staff and dentists daily.
• The screening questions include:
  • Do you or have you had any flu-like symptoms in the last 14 days, including
    -coughing
    -sore throat
    -shortness of breath
    -runny nose, sneezing, post-nasal drip, loss of smell
    -fever
  • Have you tested positive for COVID-19? When?
  • Are you awaiting results for a lab test for COVID-19? Have you or a family member previously been asked to self-isolate in the last 14 days?
  • Have you been in close contact with a suspected or confirmed COVID case in the last 14 days?
  • Have you traveled internationally or inter-provincially in the last 14 days? If so, where?
• We have set and posted a maximum occupancy of 2 people for the lunchroom and in a back office. If there are more than this maximum, masks have to be worn by the persons who are violating the 2m rule.
• No companions are allowed unless there are extenuating circumstances and for children. When a companion is deemed necessary, only one is allowed. 
•  There are only 3 chairs in our waiting room and these are spaced 2m apart to promote physical distancing.

2. Engineering Controls

The goal of this second level of protection is to provide physical barriers to transmission.

• We have installed polycarbonate barriers for the reception counter.
• Our treatment rooms are already well separated.

3. Administrative Controls

The goal of this third level of protection is to provide scheduling structure and instruction to everyone within our premises on how to maintain the best behavior to reduce the risk of exposure. The following measures have been implemented:

• We have posted a sign by our front door limiting entry to only patients with an appointment. Our local delivery personnel have also been instructed to “drop and depart”. These measures allow us to limit the number of people in our space.
• In our waiting room, all magazines and kids toys have been cleared. Only three hard-surfaced chairs remain, spaced 2m apart, and there is a hand sanitizing station on the center table which is equipped with a bottle of alcohol hand-rub gel, a box of tissues, and a foot-pedaled garbage bin.
• Upon arrival at the clinic, patients are instructed to remove their footwear, place their belongings into a sanitized bin and perform hand hygiene before being shown into their treatment room.
• Appointments are staggered to limit the incidence of encounters while moving around our space.
• Our staff members coordinate the movements of patients through the office. Patients are asked to check in from their vehicle and only enter our premises when given the green light to do so by our receptionist. At the end of a procedure, the patient has to wait until our assistant escorts them to the receptionist. We aim to minimize any encounters between patients in our hallways.
• We have discouraged our patients in using the patient washroom and to prepare for that.
• Signs and posters are mounted for patient and staff education on topics that include instructions on Hand-rubbing, Donning & Doffing of PPE, etc.

4. Personal Protective Equipment

This fourth level of protection offers our final level of separation between our staff/dentists and our patients. We follow the recommendations provided by BCCDC and CDSBC:

• Non-Aerosol Generating Dental Procedures
  Dental personnel will wear gloves, protective eyewear and level 3 surgical masks. They may choose to wear a lab coat/gown and a surgical cap.
• Aerosol Generating Dental Procedures
  Dental personnel will wear gloves, protective eyewear, level 3 surgical/N95 masks, lab coat/gown and a surgical cap. High Volume Evacuation will be used.
• General
  A level 1 mask will be used by all staff any time the 2m rule cannot be maintained. Patients may choose to bring and wear their own non-medical masks.

All staff members have been trained how to properly don and doff PPE.

5. Infection Control & Prevention

In Dentistry, Infection Control has always been, and continues to be, the core of our operations. We follow the Infection Prevention and Control Guidelines laid out by the CDSBC and include the following:

• The front door is held open so that no one has to touch door handles to enter. All other door handles and high touch areas are sanitized several times a day.
• The waiting room chairs are sanitized after any use.
• Staff and Patient washrooms are sanitized after every use.
• There are hand-sanitizing stations at multiple sites throughout the clinic. All staff members have been instructed to perform hand hygiene as follows:
  (i) upon entry & before exit of the premises
  (ii) as required for donning & doffing of PPE
  (iii) before, in between and after patient care, as needed to maintain asepsis
  (iv) as needed when handling dental laboratory materials or equipment
• Staff members have been instructed not to share food, utensils and dishes.
• Each receptionist will work out of their designated workstations for their work shifts (Mon-Wed or Thurs-Sat). They will thoroughly disinfect their workstations before switching shifts. Any other computer stations which are shared will be wiped before and after each use.
• Staff members are encouraged to carry their own pens.
• Prior to any procedures, patients are asked to rinse with 1% Hydrogen Peroxide for 1 min to reduce salivary viral load.
• All the treatment rooms and the equipment within them will be wiped with a 2 step approach, an initial detergent wipe and a second Germicide wipe. Plastic barrier shields are used where needed, for example, on the computer keyboard & mouse, on the overhead light handles, etc.
• The disinfectants used at MacKenzie Dental Centre are OPTIM 33TB DIN 02282488, Germicide3 DIN 02293072 and 0.046% Hypochlorous acid DIN 02362546.
• We use a hospital grade sterilizer (Bravo by SciCan) to sterilize our instruments.
• The ambient air in each treatment room is fogged with 0.046% Hypochlorous acid (HOCl) to provide one extra level of disinfection.
• All clinic footwear is left at the office and disinfected with HOCl daily.

As we journey through this COVID road never travelled, we encourage all our patients and staff to have patience with us and to assist us in updating and modifying these protocols as needed.

We truly appreciate your support and we endeavor to take care of your dental needs in a safe manner during these uncertain times.

Kind regards,
Dr. Philomena Gale and Staff
MacKenzie Dental Centre
May 29, 2020