By Lee Slaton, Vice President of Healthcare; Smart TrainingIn some welcome news, levels of community transmission of COVID-19 are finally beginning to fall! As of March 7, the percentage of counties with “high” or “substantial” community transmission levels fell to 76%, compared to 99% of the counties just a few short weeks ago. Hospitalizations and death rates are falling as well.
New CDC Recommendations for the General Public
In a direct reflection of this trend, the CDC recently provided new recommendations for the general public based on a measure of COVID-19 illness’ impact on health and the healthcare system. This measurement and corresponding recommendations are broken down by counties, as with the measure of community transmission. You can see this measure for your locale—along with the corresponding recommendations—here.
It’s worth repeating: these new recommendations do not apply to healthcare settings.
CDC Recommendations for Dental Practices, Healthcare Settings
The CDC’s recommendations for dental practices and all other healthcare settings are still based on the level of community transmission in the county where the healthcare facility is located. You can check out the level of community transmission where you practice here.
Highlights
Here are the highlights of those CDC recommendations for healthcare settings, along with my underlined and bracketed comments. (Note: the following text, other than my comments in brackets, was copied verbatim from the CDC page.)
♦ This guidance applies to all U.S. settings where healthcare is delivered, including home health. [That includes dental.]
♦ Implement Source Control Measures. Source control refers to use of respirators or well-fitting facemasks or cloth masks to cover a person’s mouth and nose to prevent spread of respiratory secretions when they are breathing, talking, sneezing, or coughing. Source control and physical distancing (when physical distancing is feasible and will not interfere with provision of care) are recommended for everyone in a healthcare setting. [That means all patients, visitors, and staff should be wearing masks.]
♦ If SARS-CoV-2 infection is not suspected in a patient presenting for care (based on symptom and exposure history), HCP should follow Standard Precautions (and Transmission-Based Precautions if required based on the suspected diagnosis). Additionally, HCP working in facilities located in counties with substantial or high transmission should also use PPE as described below:
NIOSH-approved N95 or equivalent or higher-level respirators should be used for:
All aerosol-generating procedures (refer to CDC’s answer to, “Which procedures are considered aerosol generating procedures in healthcare settings?”)
All surgical procedures that might pose higher risk for transmission if the patient has SARS-CoV-2 infection (e.g., that generate potentially infectious aerosols or involving anatomic regions where viral loads might be higher, such as the nose and throat, oropharynx, respiratory tract).
♦ NIOSH-approved N95 or equivalent or higher-level respirators can also be used by HCP working in other situations where additional risk factors for transmission are present, such as the patient is not up to date with all recommended COVID-19 vaccine doses, unable to use source control, and the area is poorly ventilated. They may also be considered if healthcare-associated SARS-CoV-2 transmission is identified and universal respirator use by HCP working in affected areas is not already in place.
♦ To simplify implementation, facilities in counties with substantial or high transmission may consider implementing universal use of NIOSH-approved N95 or equivalent or higher-level respirators for HCP during all patient care encounters or in specific units or areas of the facility at higher risk for SARS-CoV-2 transmission.
♦ Eye protection (i.e., goggles or a face shield that covers the front and sides of the face) should be worn during all patient care encounters.
If you wish to dig deeper on CDC’s recommendations for healthcare settings, here’s the link.
Wrap Up
Again, those are the highlights. Clinicians sometimes remark to me that the CDC only issues “guidelines” or “recommendations;” so they can’t get in trouble if they ignore them. My advice to all our clients is, whenever you read a “recommendation” or “guideline” from the CDC, you should replace those words with “rule” or “requirement.”
OSHA refers to CDC guidelines and recommendations all the time in enforcement actions when OSHA doesn’t have a specific standard to address a workplace hazard. Many state dental boards (Texas included) actually incorporate CDC guidelines and recommendations into their rules as well. A dental practice is playing with fire (and the dentist’s license) if they pick and choose or even ignore CDC guidelines and recommendations.
One final note: OSHA’s Emergency Temporary Standard (ETS) for Healthcare is still in effect, except for the vaccination mandate, which was rescinded. To avoid having to comply with the ETS, dental practices still must “screen all non-employees prior to entry; and people with suspected or confirmed COVID–19 are not permitted to enter those settings.”