Infection Control - August/September 2021 - Journal - 16

PPE Guidance for the Dental Healthcare Provider
From Honeywell Healthcare Respiratory Specialists
NEW: Latest PPE Guidance from CDC
for Dental Healthcare Professionals
During the COVID-19 pandemic, the
CDC continues to recommend additional
infection control practices for use of PPE,
along with the standard practices that
are a part of routine dental care. These
additional practices are intended to apply
when treating all patients, not just those
with suspected or confirmed SARS-CoV-2
and irrespective of the patient's vaccination
status.1
What's the Risk to Dental Healthcare
Professionals?
The CDC, in an updated Scientific Brief
on May 7, 2021, concluded the SARSCoV-2
virus is spread primarily by very
fine aerosolized respiratory droplets and
aerosol particles, via inhalation, splashes
and sprays, or contact transfer from
the hands.2
The use of powered dental
instruments creates a spray containing
particle droplets of water, saliva, blood,
microorganisms, and other debris.1
These
aerosolized particles pose a risk to dental
healthcare professionals during the
delivery of dental healthcare, not only from
SARS-CoV-2, but other potential infectious
pathogens as well.
PPE Guidance for Protection of Dental
Professionals: Unchanged
The CDC has recently stated that
recommendations for use of PPE by
healthcare personnel remain unchanged
at this time. " HCP should continue to
follow all current infection prevention
and control recommendations, including
... use of PPE to protect themselves and
others from SARS-CoV-2 infection. " 4
In addition to implementing universal
source control, which means the use of
face masks by everyone in a healthcare
facility even if they do not have symptoms,
dental professionals should continue
adherence to Standard and TransmissionBased
Precautions. Specifically, during
aerosol-generating procedures, dental
professionals should use respirators in
consideration of the level of community
transmission of SARS-CoV-2.1
(The CDC
guidance includes helpful definitions
NOTES
of different levels of community
transmission.)
PPE When There is Minimal to No
Community Transmission of SARSCoV-2
In
areas with " no to minimal community
transmission " of SARS-CoV-2, dental
professionals should use:1
* Surgical face mask
* Eye protection such as goggles or a
wraparound face shield
* Gown
* Exam gloves
PPE When There is Moderate to
Substantial Community Transmission of
SARS-CoV-2
As long as there is moderate to substantial
community transmission, dental
healthcare workers should use: 1
* N95 respirator, or higher level respirator
such as an elastomeric air-purifying
respirator (APR) or powered air-purifying
respirator for aerosol-generating
procedures (as surgical face masks do
not provide complete protection against
aerosols).
* Universal eye protection (close-fitting
goggles that seal to the eyes)
* Gown
* Exam gloves
FDA and CDC: Return to Conventional
Practices and Use Only NIOSHApproved
N95 Respirators
Recently, the FDA and CDC issued
updated guidance calling on healthcare
organizations to add more NIOSHapproved
N95s and end crisis capacity
strategies for respirators.5,6,7,8
FDA
Letters to Healthcare Providers (4/9/21
and 5/27/21) instructed: " Increase
inventory of available NIOSH-approved
respirators-including N95s and other
FFRs... " and to cease using non-NIOSHapproved
imported respirators like
KN95s.6,7
CDC stated in its PPE Supply Optimization
Strategies for dental practices that
contingency and crisis capacity strategies
are only intended for times of shortages,
1. Guidance for Dental Settings, Interim Infection Prevention and Control Guidance for
Dental Settings During the Coronavirus Disease 2019 (COVID-19) Pandemic, U.S.
Centers for Disease Control and Prevention (CDC).
2. SARS-CoV-2 Transmission Scientific Brief, May 7, 2021, U.S. CDC.
3. Guidance for Fully Vaccinated People, May 28, 2021, U.S. CDC.
4. Infection Control after Vaccination [Healthcare Professionals], April 27, 2021, U.S.
CDC.
5. Strategies for Optimizing N95 Respirator Supplies, U.S. CDC, April 9, 2021.
6. FDA Recommends Transition from Use of Decontaminated Disposable Respirators,
Letter to Health Care Personnel and Facilities, U.S. FDA, April 9, 2021.
16 USE PROMO CODE EHF WHEN ORDERING
adding " Once the supply of PPE has
increased, facilities should return to
conventional strategies. " The agency
said: " Extended use of facemasks and
respirators should only be undertaken
when the facility is at contingency or crisis
capacity. " 1
Surgical N95 Respirators are Rated for
Fluid-Resistance
In selecting respiratory protection, an
important consideration for dental
professionals is whether the NIOSHapproved
respirator has been evaluated
for resistance to penetration by fluids.
Respirators labeled " Surgical N95
Respirator " are designed to be fluidresistant
to splash and splatter of blood
and bodily fluids and intended for use by
healthcare workers. Respirators labeled
as fluid-resistant at 160 mmHg meet
the highest level of fluid-resistance as
measured on ASTM F1862, the fluidresistance
standard. Surgical N95
Respirators may also be labeled as fluidresistant
at 120 mmHg or 80 mmHg,
which are tested to meet lower levels of
fluid exposure.9
Facing the Future: Surgical N95
Respirators are Available Now
The good news is that there is currently a
great amount of Surgical N95 Respirator
availability. The time is now for dental
practice managers and infection
prevention leaders to prioritize respiratory
protection:
1. Acquire additional N95s to ensure
all staff are protected in every patient
encounter in the face of unknown risks.
2. Return to conventional practices, such
as single-use of PPE labeled for singleuse
only, like N95 respirators, per the
CDC guidance.8
3. Discontinue use of non-NIOSH
approved respirators, as directed by the
FDA.7
4. Add fluid-resistant Surgical N95s
designed for healthcare professionals in
high-fluid-risk situations like dental care.
7. Update: FDA Recommends Transition from Use of Non-NIOSH-Approved and
Decontaminated Disposable Respirators, Letter to Health Care Personnel and
Facilities, U.S. FDA, May 27, 2021.
8. Strategies for Optimizing the Supply of N95 Respirators, Situational Update as of
May 2021, U.S. CDC, May 27, 2021.
9. ASTM F1862 / F1862M - 17. Standard Test Method for Resistance of Medical Face
Masks to Penetration by Synthetic Blood (Horizontal Projection of Fixed Volume at a
Known Velocity), ASTM International.
To order, visit: www.henryscheindental.com
Infection Control - August/September 2021 - Journal

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