No dental patients? No problem

The COVID-19 pandemic forced dental practices to limit the number of patients that they see-usually, only emergency cases are allowed-and it leaves staff with plenty of time on their hands. True, some workers may have been furloughed until the all-clear is given, but for those left at the office, there are still plenty of opportunities to keep up on important, maybe even overlooked, projects.

"The current shutdown has really limited our ability to follow our typical day-to-day schedule,” Joyce Moore, RDH, an infection control consultant and clinical instructor at Bristol Community College in Fall River, Massachusetts, says. “I really think it’s providing us with an opportunity to take a critical look at what we do to practice safely. Because, while we have this pause, we actually need this time. Our daily schedule is so chockfull of tasks to complete, whether it’s paperwork or patient care or ordering. We actually, now, get a little bit of a chance to step back and take the time to reassess what we’re doing.”

Maintenance
There are plenty of hands-on maintenance chores that can be accomplished during this time. In fact, especially if equipment is not to be used for a while, it should be properly prepared. Joseph Ross, President of Ross Orthodontic, recommends the following:

• The mechanical room

“If you have a water filter system, it might be a good time to change the filter first,” he says.

“Change the vacuum filter basket strainer on the side of the vacuum pump. Turn on the water solenoid and vacuum pump, listen for any leaks or open lines, fix as needed. Turn off the vacuum pump. If you have filters on your compressor and have not changed them recently, or never, we recommend doing so. Turn on the compressor and let it fully cycle and fill up the tank. Listen for air leaks and fix as needed.”

• The chairs

“First, clean and disinfect the chairs using the CDC-recommended products,” he advises.

“Using warm soapy water, completely and thoroughly wash all vinyl surfaces. This removes any of the residual chemical build-up. Apply a vinyl/leather restorer-protectant. These are available on Amazon, most auto parts stores, Walmart, Kmart, and other home stores.

Run the chair completely, down and up, both the back and the base, several times. This will keep the gears, bearings, and bushings lubed and oiled.”

• The units

“First, clean and disinfect the units using the CDC-recommended products, with one exception,” Ross says. “We have found that using products containing peroxide on any metal surfaces may cause pitting and corrosion. We recommend not using these products on vacuum valves or syringes. With the vacuum and compressor off, clean and replace all vacuum strainers and baskets. A typical office has a small basket in the saliva ejector tip and a larger basket one in the solids collector. More than likely, it is located inside the unit itself.

“If applicable,” he continues, “remove the high vacuum and saliva ejector tips from the quick disconnect base on each hose. Disassemble each tip and drop into the ultrasonic cleaner to remove any residual particles and cleaning. Reassemble the tips using a silicone-based lubricant. Operate each tip prior to putting back in the tubing base. Most modern units come with a pneumatic valve setup that shuts off the air and water to each unit. Inside each one of these valves is a small filter. These should be cleaned and/or replaced. Turn on vacuum and air compressors, turning each unit on one at a time. Listen for any leaks and repair as needed.”

Some maintenance begins with the same sorts of procedures that one employs during normal use.

“Use each of the air/water syringes, handpieces, and vacuum valves as if you were having a normal day,” he advises. “Repair and replace any sticky valves, tighten any loose connectors, replace any leaking or worn components. It might be a good time to replace old handpiece gaskets as well.”

Now is the time to discover if equipment needs more intense care.

“If your air-water syringe has never been rebuilt, now might be a good time, as the daily use and contaminants from city water can build up and cause the buttons to stick,” Ross says. “Remove and clean the bottled water system using the CDC-recommended guidelines and chemicals. After checking each unit, empty the bottled water system bottle, return to the unit, and pressurize. Flush water from the system by using the water in the handpieces and syringe until only air comes out.”

Finally, equipment should be shut down for the long term.

“Shut off all units and the mechanical systems when finished with maintenance,” Ross says. “We recommend operating each chair and unit at least once per week to keep everything functioning properly. And refer to your individual equipment manufacturer for specific instructions on maintenance and repairs.”

Review policies and procedures
It’s not glamorous, but it has to be done regularly-ensuring that the practice’s infection control policies and procedures are current.

“This is a great time to see if the practice is up to date,” Moore says. “The infection control coordinator and the staff and the management can prepare, they can review, they can be updating office policies and protocols, looking at infection control plans. To be able to sit down and have time to review your documents, make sure you’ve got your permits, and then even having a chance to plan future staff training is really important. But it’s time consuming. We may not have the time to draw out of our regular schedule.”

Something else no one wants to do is really taking the time to perform a deep cleaning. However, the time is right.

“You can go through everything with a fine-tooth comb, cleaning top to bottom,” Moore says. “Now’s a good time to reassess the disinfectants and the chemicals that we’re using, making sure that they’ve been proven to do their job and that we know that we’re using them properly-thinking about kill time and how we use these. We have that opportunity to make sure that what we have is current, or getting rid of outdated product, and then really looking forward to reopening, making sure that we’ve got our adequate supplies and products and equipment is ready to go.”

Push papers
Many workplaces are giving employees the opportunity to work from home. That can also extend to dental office team members, especially those who need to keep up on clerical duties.

“Even from home, not being at the office, you can make sure that you have all the documents that you need,” Moore observes. “Do you have your OSHA paperwork? Do you have a current copy of your state regulations? Are you up to date on your manufacturer’s Instructions For Use (IFU)? If you ordered a new sterilizer, have you read the new manual? Can you create document that will make recording of your testing procedures work more smoothly? There’s a whole myriad of updated information on which disinfectants and chemicals are appropriate. And, do they address COVID-19 appropriately? Will they kill that bug, so to speak?”

Some professional organizations, like the Organization for Safety Asepsis and Prevention (OSAP), are making resources that were previously only available to their membership free to all.

“Right now, OSAP is giving everyone the ability to look at content that was only available to members,” Moore says. “So there’s a really good resource there. CDC is coming out with new information in the near future, so really sit down, read, and tap into that updated information. Then plan on bringing it back to your work as a resource. It should be part of your training process.”

In fact, OSAP offers informational resources specifically geared toward the COVID-19 pandemic.

Plan of attack
Looking at the entirety of a project can be overwhelming. But rather than feel like one is drowning in projects, it’s best to start with a well-thought-out plan of attack.

“Being methodical is a great way to go, so you’re not all over the map,” Moore advises. “There are checklists, there are toolkits that are available out there that will allow you to go through this process in a way where you’ve got these prompts. You can be looking at CDC guidance. There are offices sharing resources, so you can work from a template, and customize it to your practice. And then, of course, really just having a list of the products that you use in the office that will help you make sure that not only you’re organized with what you have, but you’ll know what you need in the future. You don’t have to recreate the wheel.”

Do these things:
In the event practices still need something to do, Moore recommends the following tasks:

• “Make sure that you have followed all your correct shutdown procedures for your equipment,” she advises. “And, be sure that you followed your manufacturer’s instructions for use to do this. A lot of companies have stepped up, where this information might have been a little bit more difficult to find, but companies are addressing this, putting more information up on their websites.”

• “Really take this chance to clean your space from top to bottom and make sure that when you are ready to open, that you’ve got adequate supplies,” Moore says. “Because, of course, we know supplies are maybe more difficult to get right now, and that you’ve got adequate products and your equipment’s ready to go.”

• “When you are ready to reopen, make sure that you know how to get your equipment up and running,” Moore says. “Do you have to do additional cleaning? Do you have to have other testing procedures to make sure that everything is working correctly?”

Just because there aren't as many patients coming through the doors doesn’t mean that practices don't still have work to do. Too often, practices are overwhelmed by the sheer busyness of their office that some necessary tasks get pushed down on their to-do lists. Now is a great time to check those items off the list.