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COVID-19 Guidance FAQs

Updated July 6

A patient/guardian is refusing to wear a mask in my practice due to a claimed medical condition and threatening action related to discrimination. What should I do?

Answer:

All practices must comply with the Americans with Disabilities Act (ADA). Under the ADA, the doctor is required to make reasonable accommodations, if possible, for individuals possessing medical conditions that contraindicate wearing a mask. If a valid contraindication exists, the doctor does not need to take any action that would cause “undue hardship” or fundamentally change the overall operation of the facility. The doctor is allowed to refer the patient to another facility that can reasonably accommodate the patient, such as a hospital or teaching institution, or refuse treatment.

If a true, valid medical condition contraindicating mask use does not exist, doctors are within their rights and responsibilities to refuse entry. Several fraudulent cards and fliers have been circulating during the pandemic claiming to exempt the bearer from wearing a face mask. The U.S. Department of Justice does not issue or endorse such documents. When in doubt, consult your practice advisor or legal counsel.

Are we required to abide by the AAOMS guidance or interim protocol?

Answer:

In these uncertain and unprecedented times, OMSs must do all they can to balance patient care with safety. AAOMS strongly recommends adhering to the AAOMS guidance and interim protocols for the safety of the patient, staff and practitioner; however, these are merely recommendations. AAOMS does not possess the power to dictate provider practice, and the Association relies on all OMSs to utilize their best judgment in this stressful time.

Does state law or rules supersede AAOMS guidance?

Answer:

AAOMS is not a regulatory body and, as such, cannot institute laws or regulations. Any guidance issued by AAOMS is merely a recommendation, and state law or rules supersede any guidance or direction given by AAOMS.

If the federal government, a state governor, department of health, dental board or other regulatory body issues an order affecting OMS practices, OMSs are expected to adhere to those guidelines.

Why did AAOMS take this position?

Answer:

AAOMS’s top priority remains the health of the public, patients, practitioners and staff. AAOMS continues to base its decisions on analyzation of scientific data, CDC, CMS and OSHA guidelines as well as the most current information available on COVID-19.

What constitutes “aerosol-generating procedures?”

Answer:

Most dental procedures that use mechanical instrumentation will produce airborne particles from the site where the instrument is used. Dental handpieces, ultrasonic scalers, air polishers and air abrasion units produce the most visible aerosols. (reference: JADA.ADA.org/article/S0002-8177(14)61227-7/pdf). Aerosol is created when high-powered devices need compressed air and water to work effectively. Most procedures performed by the dental team have the potential for creating contaminated aerosols and splatter. Aerosols are tiny particles or droplets that remain suspended in air. These aerosols represent an infection hazard due to their gross contamination with microorganisms and blood. A fourfold increase of airborne bacteria has been observed in areas where aerosol-producing equipment was used. Aerosols can float in air for a considerable time before being inhaled by dental staff and other patients. (reference: NCBI.NLM.NIH.gov/pmc/articles/PMC4437160)

Per the CDC's most recent COVID-19 recommendations: The practice of dentistry involves the use of rotary dental and surgical instruments (e.g., handpieces or ultrasonic scalers) and air-water syringes. These instruments create a visible spray that contains large particle droplets of water, saliva, blood, microorganisms, and other debris. This spatter travels only a short distance and settles out quickly, landing on the floor, nearby operatory surfaces, dental healthcare personnel (DHCP1), or the patient. The spray also might contain certain aerosols:

  • N95 masks are recommended for all aerosol-generating procedures performed.
  • The number of HCP present during the procedure should be limited to only those essential for patient care and procedure support. Visitors should not be present for the procedure.
  • Aerosol-generating procedures should ideally take place in an airborne infection isolation room.
  • Clean and disinfect procedure room surfaces promptly as described in the section on environmental infection control on the CDC website.

We do not have the recommended PPE in the AAOMS guidance. How should we treat cases?

Answer:

AAOMS recommends that treatment of any patients where the procedure requires the use of a handpiece generating aerosol spray be deferred unless the OMS has appropriate PPE, including an N95 mask and face shields. If appropriate and necessary PPE is not available, treatment should be delayed or alternative treatment modalities considered that do not generate aerosol spray or necessitate use of unavailable PPE. Alternative treatments, such as antibiotic therapy and all non-aerosol procedures, should be handled in a manner that is as minimally invasive as possible with available PPE.

How should we disinfect a room if COVID-19 is suspected?

Answer:

In accordance with the CDC’s Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings:

  • Dedicated medical equipment should be used when caring for patients with known or suspected COVID-19.
  • All non-dedicated, non-disposable medical equipment used for patient care should be cleaned and disinfected according to manufacturer’s instructions and facility policies.
  • Ensure that environmental cleaning and disinfection procedures are followed consistently and correctly.
  • Routine cleaning and disinfection procedures (e.g., using cleaners and water to pre-clean surfaces prior to applying an EPA-registered, hospital-grade disinfectant to frequently touched surfaces or objects for appropriate contact times as indicated on the product’s label) are appropriate for SARS-CoV-2 in healthcare settings, including those patient-care areas in which aerosol-generating procedures are performed.
  • Refer to List N on the EPA website for EPA-registered disinfectants that have qualified under EPA’s emerging viral pathogens program for use against SARS-CoV-2.
  • Management of laundry and medical waste also should be performed in accordance with routine procedures.
  • Additional information about recommended practices for terminal cleaning of rooms and PPE to be worn by environmental services personnel is available in the Healthcare Infection Prevention and Control FAQs for COVID-19.

If I or one of my staff test positive for COVID-19, do I need to alert my patients?

Answer:

Generally, yes. Check with the state department of health or dental board for any state-mandated reporting requirements. Also be sure to check with a malpractice carrier for any recommendations.

One of my patients tested positive for COVID-19. Can I still treat the patient in my office with appropriate PPE?

Answer:

No. It is not recommended that any COVID-19-positive patients be treated in a dental office setting unless airborne transmission precautions can be maintained. COVID-19-positive patients should be treated in a hospital isolation room with negative pressure. Unless urgent, treatment should be delayed until 14 days after resolution of symptoms. These recommendations are subject to change based on availability and reliability of SARS-CoV-2 testing. Refer to the CDC, FDA and state and local public health authorities for the most up-to-date recommendations.

One of my patients works with positive COVID-19 patients. What is the recommended protocol?

Answer:

There is no formal CDC recommendation regarding these patients, so caution and professional judgement will be key.

The real matter to address is if the patient has had exposure to COVID-19-positive patients. For example, if the patient is a nurse treating COVID-19-positive patients, he or she is likely using a maximum level of PPE. Providing care to a COVID-19-positive patient with appropriate PPE is not considered an exposure. If he or she lives with someone or is in close personal contact with someone who is found to be COVID-19-positive, then that is an exposure, and the patient should be presumed to be COVID-19-positive as well.

While there is little guidance, the recommendation is that patients who have been exposed complete COVID-19 testing or be quarantined for 14 days prior to being seen in an outpatient setting. If there is an emergent situation, the patient in this instance should be seen in a hospital setting following institutional protocols with airborne transmission precautions, and COVID-19 testing should be completed if possible. As with all patients, ask the patient to follow up within 14 days if symptoms of COVID-19 develop.

If one of my staff members contracts COVID-19, am I liable?

Answer:

Please consult an employment practice attorney, malpractice insurer and HR advisor for advice in this area. Keep in mind, all employers are required to follow OSHA protocols per federal labor laws. As an employer, you are required to provide administrative, engineering and work practice controls, education and training as well as appropriate PPE. Though there is always a potential for employment practice accusation and litigation, compliance with appropriate and diligent hazard risk mitigation strategies should limit liability exposure risk.