Occupational COVID-19 risk to dental staff working in a public dental unit in the outbreak epicenter.

OBJECTIVE: The management of the COVID-19 outbreak occurred in Lombardy (Italy) implied that non-COVID-19 health care was remodeled, limiting adequate resources in non-hospital public dental healthcare settings. This situation offered the opportunity to investigate the occupational COVID-19 risk to dental staff in public non-hospital dental units. METHODS: An infection control protocol was designed for dental health care in the Territorial Health and Social Services Authority (ASST) "Melegnano and Martesana" (Milan). Since specific guidance from central authorities was lacking, information was gathered from international public health organizations. The probability to visit asymptomatic COVID-19-infected patients was estimated, and the occupational risk to dental staff was calculated. RESULTS: The probability to visit asymptomatic patients passed from 1.2% (95% confidence interval -95 CI, 0.6%-2.5%) in the first period (20 February-15 March 2020) to 11.1% (95 CI, 5.8%-23.6%) in the second period (16 March-30 April). Dentists and dental assistants did not develop COVID-19, while one nurse did, the nature of her occupational risk was unclear, as nurses provided prevalently non-dental health care. The probabilities of developing COVID-19 per worked hour per person excluding and including this uncertain situation were 0.0% (95 CI, 0.0%-3.2%) and 0.9% (95 CI, 0.1%-4.7%). CONCLUSION: Relatively simple infection control procedures were enough to control occupational COVID-19 risk during the outbreak.

Environmental Disinfection Strategies to Prevent Indirect Transmission of SARS-CoV2 in Healthcare Settings

(1) Introduction: The novel respiratory syndrome coronavirus 2 (SARS-CoV-2), also called coronavirus disease 2019 (COVID-19), is rapidly spreading in many countries and represents a public health emergency of international concern. The SARS-CoV-2 transmission mainly occurs from person-to-person via respiratory droplets (direct transmission route), leading to the onset of mild or severe symptoms or even causing death. Since COVID-19 is able to survive also on inanimate surfaces for extended periods, constituting an indirect transmission route, healthcare settings contaminated surfaces should be submitted to specific disinfection protocols. Our review aimed to investigate the existing disinfection measures of healthcare settings surfaces, preventing the nosocomial transmission of SARS-CoV-2. (2) Materials and Methods: We conducted electronic research on PubMed, Scopus, Science Direct, and Cochrane Library, and 120 items were screened for eligibility. Only 11 articles were included in the review and selected for data extraction. (3) Results: All the included studies proposed the use of ethanol at different concentrations (70% or 75%) as a biocidal agent against SARS-CoV-2, which has the capacity to reduce the viral activity by 3 log10 or more after 1 min of exposure. Other disinfection protocols involved the use of chlorine-containing disinfectant, 0.1% and 0.5% sodium hypochlorite, quaternary ammonium in combination with 75% ethanol, isopropyl alcohol 70%, glutardialdehyde 2%, ultraviolet light (UV-C) technology, and many others. Two studies suggested to use the Environmental Protection Agency (EPA)-registered disinfectants, while one article chooses to follow the WST-512-2016 Guidance of Environmental and Surfaces Cleaning, Disinfection and Infection Control in Hospitals. (4) Conclusion: Different surface disinfection methods proved to reduce the viral activity of SARS-CoV-2, preventing its indirect nosocomial transmission. However, more specific cleaning measures, ad hoc for the different settings of the healthcare sector, need to be formulated.

Model for Taking Care of Patients with Early Childhood Caries during the SARS-Cov-2 Pandemic.

Pending the availability of vaccines to contain the SARS-CoV-2 pandemic, the current solution is "social distancing" with a reduction of dental treatments to those assessed as urgent and emergency cases. These treatments also involve Early Childhood Caries (ECC) due to the fact that this disease affects preschool children (a vulnerable population) and, in addition, shows a propensity to evolve into more serious complications (dental pain, infections). A narrative review was carried out to support a protocol for treating ECC with efficacious and safe (in terms of SARS-CoV-2 transmission) procedures. Protocol involves criteria for patients' selection remotely (telemedicine), and well-detailed criteria/equipment and hygiene procedures to combat against SARS-CoV-2 transmission. Moreover, the protocol proposes innovative caries treatments, named Minimally Invasive Treatments (MITs), well known in pedodontics for their high level of children's acceptance during dental care. MITs allow for caries removal (particularly in primary teeth) without any high-speed rotating instrument cooled with nebulized air-water spray (with high risk of virus environmental diffusion), usually adopted during traditional treatments. For evaluating MITs effectiveness in caries management, only Systematic Review and Randomized Controlled Trials (RCTs) were included in our study, without any risk of bias assessment. The indications proposed in this protocol could support clinicians for the temporary management of ECC until the SARS-CoV-2 pandemic ends.