ABSTRACT
Background: The COVID-19 pandemic was a challenge for all dental professionals who had to rapidly update infection prevention and control (IPAC) guidelines and protocols due to increased risk of SARS-CoV-2 transmission during common aerosol-generating procedures (AGPs), and a lack of consensus on how best to mitigate the risk of transmission in a dental office. Thus, the purpose of this descriptive study was to compare the variance in IPAC guidelines for dental offices that emerged, and to assess practice consistency from early to mid-2020. Methods: A comprehensive literature search was conducted from May 26 to July 8, 2020 for IPAC documentation specific to the dental office during the COVID-19 pandemic. Documents that met the inclusion criteria were independently reviewed. Data was extracted using a framework based on the following IPAC domains: pre-appointment, waiting room, personal protective equipment (PPE) selection, treatment room, and post-dismissal. Results: A total of 67 IPAC documents specific to dental offices were reviewed in this study. Included documents originated from 22 dental associations, 17 peer-reviewed articles, 13 dental regulators, 11 government bodies, two public health units, and two dental corporations. There was a great degree of variance with IPAC guidelines from the pre-appointment stage, during treatment, and post-treatment. Recommendations that emerged with some level of consistency involved pre-screening patients for COVID-19 symptoms (97%), staggering appointments (84%), social distancing, minimizing occupants in the waiting room, wearing a face shield over protective eyewear for AGPs (92%), and preprocedural rinses (84%). There was less consistency with recommendations for consolidating multiple appointments (36%), waiting room ventilation (46%), N95 masks (47%) versus FFP2/FFP3 masks (30%) use for AGPs, fit-testing respirators (37%), enclosing open operatories for AGPs (28%), prioritizing minimally invasive procedures (30%), and using third-party laundry companies (32%). Conclusions: The risk of SARS-CoV-2 transmission, lack of consensus on mode of spread, and need for rapid action resulted in a significant variation in most downstream IPAC interventions in the hierarchy of controls, including choice of PPE, treatment room, and post-dismissal domains. Upstream interventions, including pre-appointment and waiting room domains, were relatively consistent in practices in early to mid-2020.
ABSTRACT
Background. Breath samples collected from patients infected with respiratory viruses are necessary for viral detection using breath analyzer devices. Given the highly transmissible nature of many of these illnesses, sample collection requires a multilayered approach to ensure the safety of the research staff responsible for obtaining and transporting these samples. Our team established a protocol to minimize exposure to and transmission of COVID-19 when collecting breath samples. Methods. We collected breath samples from 64 participants, of which 31 (48.4%) were positive for SARS-CoV-2 at the time of their visit. Before we started sample collection, biosafety inspection was conducted. We used a five-pronged approach to enhance safety and minimize transmission. First, we collected specimens in an outdoor space while the patients were seated in their vehicles. Second, we used a disposable mouthpiece and a one-way valve tofill a 1L TEDLAR bag. Third, patients were instructed to close the valve tightly before returning it to the staff. Fourth, we placed the bag in secondary containers which were placed in tertiary containers to minimize any contact with aerosols in the TEDLAR bag. In the last step, we placed a portable HEPAfilter near the indoor sample processing unit to minimize exposure and air contamination with the samples. Study staff donned all forms of necessary personal protective equipment, including gloves, gowns, N95 respirators, and protective eyewear, during sample collection and transportation. Results. A total of 64 breath samples were collected from 64 adult participants from February to March 2022. A total of 30 participants (46.9%) were within 7 days of their initial diagnosis. All participants were able to successfully collect samples without additional resources or attempts. All samples were able to be transported successfully into the lab. No staff contracted COVID-19 during the study period. Conclusion. Layered safety measures, including protective equipment, physical barriers, and well-ventilated environments mitigated the risks associated with breath sample collections from infected participants.