The Compliance Divas Podcast
Our podcast covers current topics such as infection prevention and control, OSHA and HIPAA compliance for dentistry. We discuss the latest regulatory information, answer frequently asked questions and give suggestions for dental practices to make compliance easy and sustainable. The Compliance Divas are a trusted source for consistent, accurate information based upon current guidelines, standards, science, and recommendations.
The Compliance Divas Podcast
#107 CDC Updated Infection Control Guidelines for Healthcare - May 8, 2023
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Even though the COVID-19 Medical Emergency Declaration has ended, COVID-19 infections have not. Although some guidelines, such as practicing source control (masking at all times in the healthcare facility) is no longer required, most of the CDC's recommendations remain unchanged. In this episode, the Compliance Divas will discuss these updated guidelines in detail and relay what dental professionals need to know about the spread of aerosol transmissible diseases.
Resources:
- CDC Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic - Updated 5/8/2023 https://bit.ly/3OxmgBa
- ASHRAE Coronavirus (COVID-19) Response Resources https://bit.ly/3WtCMUH
- National Assoc. of County and City Health Officials (NAACHO) Directory of Local Health Departments https://bit.ly/3q8VoNF
- State of CA Dept. of Industrial Relations COVID-19 Prevention Requirements - Effective Until Feb. 3, 2025 https://bit.ly/3BMQZm6
- The CA Workplace Guide to Aerosol Transmissible Diseases https://bit.ly/3IuQVev
Welcome. I'm Leslie Cannon. I'm Mary Gavoni.
SPEAKER_00Amanda Harvey. I'm Olivia Juan, and together we are the Compliance Divas.
SPEAKER_01Welcome to the Compliance Divas Podcast. I'm Mary Gavoni and I'll be the moderator for this episode. The compliance divas bring clarity and simplicity to compliance by navigating regulatory compliance to keep you on course. You can subscribe to the Compliance Divas Podcast through your favorite podcast channel or on our website, thecompliancedeivas.com. All of the resources we mentioned during this podcast can be found in the show notes on your podcast app or on our website, thecompliancedivas.com. And you can always submit questions to us via email at support at thecompliancedivas.com. On May 11th, 2023, the National Medical Emergency for COVID-19 officially ended. In response to this, the Centers for Disease Control and Prevention updated its interim infection prevention and control guidance. This episode will highlight the updates that are applicable to dentistry. And the CDC also updated its recommendations on ventilation in buildings, which will be covered in a future episode. So don't ditch your HEPA filtration units just yet. And the the reality is that some people may question why the CDC is even continuing to have interim guidance for COVID-19? And the answer to that is because COVID-19 is still here and it is still spreading. So, Leslie, let's start off our discussion talking about what's changed, what hasn't changed, and how can practices get information about the COVID-19 spread in their community now that we don't have the COVID tracker anymore?
SPEAKER_02Well, Mary, this is a very good point because dental offices need to know that with CDC, they base their update, this recent update, on the currently available information about COVID-19 and the situation in the United States. So the updates that we have here as of May 8th are made to reflect the high levels of vaccine and infection-induced immunity and the availability of effective treatment tools. So the guidance actually provides what's called a framework for facilities to implement and select infection prevention and control practices. So that includes universal source control based on their individual circumstances and levels of respiratory virus transmission in the community. And I just want to emphasize respiratory virus transmission may not be specifically just COVID. It may be other viruses that are circulating in the community. So the guidance, again, here is designed for healthcare workers, not non-healthcare facilities. So this is not restaurants or other settings outside of healthcare. And the CDC's main landing page for COVID-19 is going to help dental practices navigate the information regarding modes of transmission and vaccines and CDC-related topics on COVID-19. So this is where it's important for dentists, employers or supervisors of dental settings to be aware that there may also be other local, territorial, tribal, state, or federal requirements that apply or may apply, including anything promulgated by OSHA. And I want to just make a quick little note to our California listeners that Cal OSHA still has in place what's considered to be the non-emergency COVID-19 regulations, and they'll be in place until February of 2025. So that includes respiratory protection and screening patients, and I'll get into a little bit more about that later in our podcast. But I also want to make sure that our readers understand that with the end of the public health emergency, CDC is no longer receiving data that they need in order to publish what we call, feel fondly, our beloved COVID data tracker, because we could track with this tracker not only the community levels, which was what other types of businesses would use to gauge their source control or other infection prevention protocols on. And then we had the community transmission, which is what healthcare facilities would use to gauge their infection prevention protocols on. And we could see as our community levels seemed to like 98% of the country was in very low community transmission, but we still had some very big areas of high community transmission in our uh trackers. So we we were still able to rely on that to be on our toes. While the tracker is not available or does not have the current information, the place that our listeners can get information about COVID-19 transmission in their local area is from a resource that we're going to provide on the Compliance Divas website and in our show notes. And it's called the Directory of Local Health Departments. You can click on your state, and then when you get to your state, you can actually take a very close look at your community and you can see how your public health department has directed your community to move forward. And remember, again, there may be regulations that are applied in certain communities where they have stricter protocols surrounding COVID-19 prevention. So that's where you can find the information. And as to your other question, it's important to recognize that the dental practice recommendations have not changed for COVID-19 according to CDC. All of the same recommendations that were listed in the September 2022 version of recommendations for dental settings are exactly the same, except there's one area where, when they tell us about performing aerosol-generating procedures on patients who are not suspected of having SARS-CoV-2, that we should be using N95 respirators. Now, in the uh previous version, it said in counties with high levels of transmission. Well, since the COVID data tracker is not giving us that information any longer, they have changed that to wearing N95 respirators as the SARS-CoV-2 community transmission. They use the word increases. And so the only place you're going to be able to find your community levels or transmission would be to your own local public health department to see if there's increases. So with that, our our listeners should be aware that the CDC guidelines that they have in their practice that are dated September of 2022 are still the same for dental facilities. It's just how you get the community levels in your area has changed a little bit as to what resource you'll go to.
SPEAKER_01Thanks, Leslie. That's really, really helpful. And the updated guidance or guidelines from May 8th will be in the resources in the show notes and on our website. Olivia, Leslie mentioned source control. Can you go over that for us with us? What are the current recommendations on source control and PPE?
SPEAKER_00Sure, Mary. There's really not a lot of change from a couple of guidelines ago, meaning we recognize the fact that it was relaxed in wearing source control in healthcare facilities. But the point is well made in this guidance that even if the facility doesn't require source control, it should allow individuals to make that choice. So if they still want to wear source control, they can. And Mary, I've seen that with some of our clients where maybe the doctor is requiring source control and you see the employees masked up like you did during COVID. So that certainly can be their inner practice rules that they are following. Or as the guidance mentions, if the individual chooses to wear source control. And with that said, this guidance mirrors what we've learned before that when we're making a selection for different options of source control, we have the choice of using an IASH-approved respirator. Or we could use up those KN95s because those were approved for emergency use only while the supplies of N95s had been depleted. They can no longer be used clinically. And so you may want to use up those KN95s for source control. And we can also wear a barrier face covering that meets the ASTM standard requirements for workplace performance and work performance plus mask or a well-fitting mask. But I think the point is made that, you know, if you want to wear source control and you're not sitting chair side, you know, we're talking about like the admin areas or other areas of the dental office, then that would be up to the individual or whoever is managing or owns that practice. But I can tell you, Mary, even though some of these guidelines are relaxed, some of us take it really seriously, not just for COVID. You know, what are the other respiratory infections out there? So, for example, all of the divas are traveling soon to Arizona. And even though it's not required to wear source control in an airplane, I will probably wear a mask because I do not want to pick up a respiratory infection in the plane in close quarters with other individuals and then come home from my trip and be sick and miss work. And so these are things that we can make individual choices on. But do want to mention, Mary, that source control is recommended for individuals in healthcare settings if there's suspected or confirmed SARS-CoV-2 infection or other respiratory infection. So, you know, you can remember years ago when we were all working in dental offices, people would come in and work, even though they had a runny nose or they were coughing. If somebody's running a fever, they should not be coming to work. Hands down, don't come to work if you're running a fever and get other people sick. But if there are symptoms, they need to have that courtesy and to wear source control. And also if they've had close contact, whether that be patients or visitors or a higher risk exposure with someone with SARS-CoV-2 infection for 10 days after their exposure. So I think this is good information that we keep in mind in moving forward. That I think the point you well made, Mary, that even though the pandemic is officially over, COVID is here to stay. And so are other respiratory infections. And all of this guidance is very helpful in keeping employees healthy and also making sure patients don't leave with something that they didn't have in the first place. And also, Leslie touched on this about the aerosol generating procedures. So as SARS-CoV-2 transmission in the community increases, and we know that by looking at these health department reports, then it's recommended to wear the NIASH-approved respirator for those aerosol generating procedures. And Mary, I can tell you this if I was still a registered dental assistant, working chair side, I would like that peace of mind that I had a good quality respirator to protect against respiratory infections, whether that be COVID or other things that can be transmitted through aerosol. So don't throw your guidelines away. We need to continue to review them and put them in place. And also, if you're the safety coordinator and you're following our podcast, this is good content for your team meetings just to give some healthy reminders about source control.
SPEAKER_01Thanks, Olivia. I'm with you. I still wear a mask, a face covering on an airplane. I don't want to get sick either. I think I will forever do that, even beyond the spread of COVID. And I also, if I were working chairside, I would be wearing an N95 respirator with my face shield for protection. One of the things our listeners may be questioning because we have emphasized so much requirements or recommendations for employees, what about the patients? If you're in an area of very low transmission, you are not required to ask your patients to wear a face mask for source control when they come into a practice. And I know many people dropped that requirement a very long time ago because they were tired of fighting with patients about not wanting to wear one. But I wouldn't be surprised if we don't, in some practices, still see people come in with their masks. I see quite a few people in my area in Kansas wearing their face masks when they're out grocery shopping or you know, in other public areas. So I think there is still some concern on the part of people, but the majority, I think, just ditch the face mask and let's be done with it. So, Leslie, you're going to uh address some issues that our Diva Linda, who couldn't be with us here today. I think we've already talked about the N95 respirator issue that Linda wanted to address, but what about other engineering controls that are in the appendix to the CDC guidelines and indoor air quality? What is the CDC saying about that?
SPEAKER_02Well, I know our Steva Linda would like us to address optimizing the use of engineering controls and indoor air quality. And so when we talk about optimizing engineering controls, what we mean is we want to try to reduce or eliminate exposures by shielding healthcare providers and other patients from infected individuals. So that might include uh physical barriers at reception. I love seeing the plastic barriers at the reception. I think I'm everyone's used to that at this point. And so that if you have taken them down, I recommend putting them back up again, especially now that people are more used to not having source control. But if you haven't taken them down, I recommend that you leave them up. People are used to seeing them and they're an extra added layer of protection. So that's one engineering control. And in California, again, CalOSHA has eliminated the requirement for those plastic barriers to be up. But on a precautionary basis, I recommend that they still be up. Now, also, the CDC guidelines recommend taking measures to limit crowding in communal spaces. And that might still include scheduling your appointments to limit the number of patients in your reception area or treatment areas. And they also recommend exploring options to improve ventilation delivery and indoor air quality, not only in patient rooms, but in all shared spaces. And there's guidance on ensuring that ventilation systems are operating properly, and other options for improving air quality are available from several resources that are listed in the CDC guidelines, including a new document that was just published on May 12th that is a CDC recommendation for COVID-19 for ventilation in buildings. So that's a great document, but it's a huge document, and that's going to require a completely separate podcast. And I know we're going to be planning for that very, very soon. But the other resources that you might look at for indoor air quality include guidelines for environmental infection control in healthcare facilities. And then there's also the American Society of Heating, Refrigerating, and Air Conditioning Engineers. They call that ASHRAY. Their resources for healthcare facilities also provide COVID-19 technical resources. So that will be in the document that we will make available in our show notes. You just simply look at the part about optimizing the use of engineering controls. And that's going to be in section one. So you can get to those other resources. And then there's also a document that actually they mentioned ventilation in buildings, but I think that the new document that was released on May 12th, I'm not sure if that link will lead right to that new document. So we'll make sure that we have that document as available for our listeners as well. I do want to touch on N95 respirators for just a moment because I think there may be the misconception that we're all safe when we wear a surgical face mask. And when we're performing an aerosol generating procedure in dentistry with a surgical face mask, we are still inhaling respiratory viruses. And so there are still people who are asymptomatic or presymptomatic with many different types of viruses, not just COVID-19, but influenza. And so they come to their dental appointment. They're not runny nose or watery eyes or anything like that where we see outward observable symptoms. So NIOSH approved respirators for all generating procedures is still recommended. And to just recap what an aerosol generating procedure is in dentistry, when we're looking at this, we're talking about any procedure that we perform with a hand piece, an air and water syringe, ultrasonic scalar, any of those devices, air polishers, anything like that, is going to generate aerosols that are going to propel out of a patient's mouth. So an N95 respirator and eye protection, meaning either goggles or face shield, not simply trauma glasses or prescription glasses or loops, because respiratory viruses may also be absorbed through the mucous membranes. So your eyes, nose, and mouth are perfect mucous membranes. The respirator covers the nose and mouth. But what are we doing about eye protection if we've just gone back to what we did pre-COVID? Thanks, Leslie.
SPEAKER_01That was awesome. Olivia, what about testing? Now that the pandemic's over, is it still important for patients andor healthcare workers to be COVID-tested if they have symptoms?
SPEAKER_00Yes, Mary, that's so important. And I thought that it was interesting in the guidance, it mentioned that patients who are moderately to severely immunocompromised may produce replication-competent virus beyond 20 days. That's a long period of time for someone to still shed virus and think about how many people they can come in contact with during that 20 days. That being the first category, patients who are symptomatic, resolution of fever without use of fever-reducing medications, and in bullprint, symptoms such as cough, shortness of breath have improved, and the results are negative from at least two consecutive respiratory specimens collected 48 hours apart. And so I think that that's important to recognize that they still have the testing guidance listed there for people with symptoms. And then on the other hand, Mary, patients who are not symptomatic, they should still be tested. Results that are negative from at least two consecutive respiratory specimens collected 48 hours apart. So once again, don't throw your guidelines away. There's still opportunity for infection, and we want to make sure that individuals are being tested so that they don't infect other people.
SPEAKER_01Thanks, Olivia. I so like that you emphasized don't. Throw the guidelines away, even though we're not using the P-word pandemic anymore. COVID is still there. There's other respiratory infections, as we have said, that we need to protect ourselves from. And I think in many cases, we sort of took that for granted in the past until COVID presented such a risk to us, especially in the beginning of the pandemic when so many people were dying from COVID. Leslie, you had a comment that you wanted to share.
SPEAKER_02Yes, I mean, along with don't throw out the baby with the bathwater, you know, the recommendations still uh indicate that we should be encouraging our patients to stay up to date with COVID-19 vaccinations, and we should identify a process to make sure we manage individuals with suspected or confirmed CARS SARS-CoV-2 infections. So that still means screening and it still means placing a visual alert. So there are posters that CDC has about the signs and symptoms of COVID that you could post outside your facility that tells a patient not to come into the practice if just with a place for your phone number that call and let them know that you're experiencing symptoms before you walk in the door. And you know, same in California, you must screen patients according to the aerosol transmissible disease standards. So the screening process is still required. And CDC gives some great recommendations in section one of this particular document that we're discussing today on how you might handle these various different screening protocols and how you might handle a patient who has indicated that they have some of the uh criteria, but there's like three different criteria that indicates that they may be infected with SARS-CoV-2. So we want to make sure that we are not only adhering to the guidelines, but uh in certain states like California, it's the law to continue to follow certain steps for screening patients and for using N95 respirators. I can't stress that enough because I know people are anxious to get rid of the requirement for N95 respirators, but it's still required.
SPEAKER_01Absolutely. And thank you for bringing that up, Leslie. The reality is that screening patients for respiratory symptoms is just good business practice because we don't want to be exposed and then somebody gets sick because of that exposure to either a patient or somebody coming in from the outside. It certainly isn't the level of what it was before, where we took the temperature of those patients where they walked in the building and we didn't let them get past the front desk if they had a fever or if they were having symptoms, but certainly letting patients know that if they do have respiratory symptoms and we ask those questions prior to their appointment, that we're going to postpone their treatment out of an abundance of caution. And hopefully, those patients who might have concerns about that now have figured out that there are a lot of hazards that we need to protect ourselves from. So, in closing, again, even though the pandemic is over, our infection prevention and control guidelines have very, very few changes. And we still need to be having our guard up about respiratory symptoms, whether it's a member of the team or it's a patient coming into the practice. So we will be publishing a podcast in the very near future about the ventilation guidelines that have been updated by CDC. So please watch for that. And we thank you for joining us on this episode. The compliance divas bring clarity and simplicity to compliance by navigating regulatory compliance to keep you on course. If you have questions, submit them by email to support at the compliance divas.com. And also the resources that we talked about in this episode will be listed in your show notes on your podcast app and on our website, thecompliancedivas.com. Thanks for listening.