Today we continue our plan with getting ready for a phased return to dentistry and joining the equivalent to medical and hospital protocols when delivering AGP – (Aerosol Generating Procedures). There are some new terms to understand and systems that need to be updated, trained, followed and added to your protocols.

Begin with the facility and assigning which rooms will be for Aerosol Generated Procedures and make sure they have signage at the entrance and a handwashing station inside and outside for the Donning and Doffing process.

The AGP treatment room must be closed and have a shut door, and only the patient, dentist and assistant will be permitted in the treatment room. The operatory door is only opened once after the procedure has commenced to discharge the patient and for an assistant to exit the room.

All clinical team members must remove all jewellery, piercings and nail polish. They must also put up long hair in a bonnet and remove FACIAL HAIR in order for their mask to fit securely and be properly seal against your skin.

The new terms and process of ‘Donning’ refers to putting on Personal Protective Equipment in a clean, sterile area. The practice must have an area that is clean or hallway section that is used for Donning and storage of all your PPE equipment, such as Caps, Gowns or Lab coats, Masks/N95 Respirator, Face Shields and Alcohol-Based Hand Sanitizer.

The PPE must be Donned (put on) in the clean Donning area that has a hand hygiene station with alcohol based anti-bacterial, anti-viral solution, a trash bin and enough area to put on PPE materials on safely.

** Note: Once the PPE is on it is key not to go anywhere else except the treatment room.

The simple steps of the process for PPE Donning are:

  1. Proper hand hygiene with 2-3 pumps of sanitizer, which should take 20 seconds to rub in. Rub the front of the hands and the back and get good contact between the two palms, and get in between the fingers. Don’t forget about the thumbs!

 

  1. Gowning Up – open the gown and check for defects such as holes, tears or tabs that may be missing. Once inspected and safe, place your arms in the sleeves first and then tie the gown in the back.

 

  1. N95 Mask – cup it in your hands and place on face putting the first strap over the crown of your head.  Bring the second strap over and down to the nape of the neck where you don’t have any hair.  Make sure the straps are flush and you can mould the mask to your face starting at your nose and your cheeks to ensure there is a solid seal.

**Note: Check for any air leaks – exhale and feel for any air leaks around, if you have any – you need to readjust!

  1. Face Shield or Goggles  – place the padding from the face shield over your forehead and make sure the face shield fits over your glasses and comes all the way down below the mask.

 

  1. Gloving up – put thumbs into sleeve holes like your ski coat and put on gloves as normal above the cuff of your sleeve. Make sure there is no skin showing between the glove and the gown.

*Note: Sometimes people will double glove as a precaution

Once the procedure is over, the patient is exited on their own to the checkout station for processing. They will exit using physical distancing, and you can use non-mandatory plexiglass if desired.

The clinical process of ‘Doffing’ of the PPE is to be done in the operatory, which is the decontamination side and has a laundry receptacle with a lid, garbage can with a lid, eye protection and disinfection receptacle.

The process of Doffing PPE before exiting the AGP room and how to remove the PPE includes the following steps:

  1. Gown removal – use gloved hands remove your gown in a quick movement keeping hands in sleeves and give yourself a hug to pull off from shoulders. During this motion, wrap the gown into a bundle and put in closed lid laundry or garbage receptacle.

 

  1. Gloves – come off with the gown inside out and should be disposed in a closed garbage can.

 

  1. Hands – wash hands using proper hand hygiene protocols.

 

  1. Face shield – grab from the sides and pull back or from the front – do not pull off from the back near your hair, as you don’t want to possibly contaminate your hair.

 

  1. Mask – keep the N95 mask on until you leave the dirty space.

 

  1. Once you leave the room, repeat the hand hygiene step.

 

  1. Remove the N95 mask safely by bending slightly forward with your head down and grab the lower strap first. Pull it over your head and release the second strap.

 

  1. Remove hair bonnet and dispose.

 

  1. Perform the hand hygiene step again (you can also use soap and water if possible and wash up to the arms).

The New Normal may seem daunting and overwhelming. However, with a proper plan, organization and team in service training in place, along with continuous practice, we will do our part to contain the COVID-19 virus.

One of our Transitions family client’s is married to an anesthesiologist. She was kind enough to share her reference for donning and doffing in the video below:

 

 

 

 

 

For more helpful tips, be sure to check out our full COVID-19 Survival Guide.

Lisa Philp
Chief Visionary Officer
Transitions Group