COVID-19 Update
We partner with the Dental Surgery Center of DC to provide care in an AAAHC accredited healthcare facility. Please see below the Dental Surgery Center of DC's policies to address COVID-19.
Dear Patient, December 9, 2020
At the Dental Surgery Center of DC, patient health and safety is our number one priority. We are doing everything we can to ensure that you and your family stay safe during this time of uncertainty.
Our standard procedures include:
· Wipe down all surfaces and all equipment in patient treatment areas with hospital-grade disinfectant cleaning solution before each patient is treated
· Each patient’s anesthesia breathing circuit has a filter that filters out 95% >= of viral and bacterial particles
· Sterilize all equipment that will be used in the facility before each use
· Each healthcare provider uses a new surgical facemask and personal protective equipment (i.e. gowns, gloves) for each patient
· No patient who has been sick within the last 6 weeks will be treated
· No staff member who is or may be sick is allowed to come to work
· All staff members are required to wash their hands with soap for at least 20 seconds whenever they put on or remove gloves
· We use isolite isolation systems with suctioning capabilities to prevent the escape of aerosolized
In addition to our standard procedures, we are implementing the following policies to prepare for COVID-19:
· Postponing elective procedures, performing urgent cases only
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Following ADA[1] and MSDA, MDH[2] guidelines, we will not be doing elective treatments, and will only treat urgent cases (please speak with your doctor if you have any questions about this)
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The patient and dental surgeon must confirm and sign a document confirming that they understand the potential for complications related to COVID-19 and that case is urgent
· We have installed an aerosol extractor to vacuum out potential aerosols during treatment
· Patients who have been exposed to COVID-19 or who have one of the following symptoms will be asked to postpone treatment (and may be asked for evidence of a negative COVID-19 test)
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Shortness of breath or trouble breathing
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Cough
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Fever or chills
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New fatigue
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Muscle or body aches
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New or unusual headache
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New loss of taste or smell
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Sore throat
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Congestion or runny nose
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Nausea or vomiting
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Diarrhea
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* Note that This list does not include all possible symptoms. CDC will continue to update this list as we learn more about COVID-19[3]
· Avoiding Contamination Risk
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We disinfect all door handles and sink faucets at the beginning of each day and each hour[5]
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All staff members wear N95 or KN95 masks with a surgical mask over the N95 or KN95 masks
· Waiting spaces
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We will lock the front doors to the office to prevent uncontrolled foot traffic
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We will take the temperature of everyone entering the building (including staff, patients, deliveries, servicepeople, etc)
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Patients and their families awaiting treatment will wait in their cars. Families will wait in the car while waiting for surgery to be completed, and will be admitted to the PACU when the patient is waking up
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We disinfect all surfaces in the waiting room at the beginning of each day and between each patient and their family[6]
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We request patients and their families respectfully maintain social distancing of 6+ feet from other patients and their families at all times
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We request that patients come with one responsible adult, and no additional parents, guardians or family members
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We have removed all toys / magazines / books from our waiting room to ensure there is no cross-contamination from one patient to another[7]
· Patient Health Status
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Any patient who has a fever, sore throat, a cough or respiratory symptoms will be asked to reschedule their appointment
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We will ask the patient in a pre-op phone call and once they arrive at the facility
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We will take the temperature of everyone (staff, patients, family members, and service providers) as soon as they enter the facility, and anyone who has a fever of 100 degrees or higher will be kindly asked to not enter the facility (including staff members)[1]
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We will postpone treatment for any patient who has a family member who has been sick within the last 30 days
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Any patient who wishes to postpone treatment may make an appointment at another time in the future
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Any patient who has traveled or has a family member who has traveled via airplane within 14 days will have their treatment postponed[9]
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To preserve patient and staff health and safety, we reserve the right to postpone treatment for any patient for any reason or no reason at all
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Any patient who has been exposed to COVID-19 in the facility will be notified of COVID-19 exposure in accordance with state and federal guidelines[10]
· Staff Health Status
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All staff and doctors who have traveled outside the US will wait at least 14 days before coming to work[11]
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All staff members have their temperature taken when entering the building. Anyone who has a fever or a cough will be sent home.
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Staff who have been exposed to COVID-19 will be required to self quarantine and obtain a test before returning to work
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General
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We are posting these guidelines on our website and on our front door
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We will return to normal operations and scale back COVID-19 related policies as the Maryland Department of Health indicates that the pandemic risk has decreased and allows for normal operations in healthcare facilities. Specifically, we expect this to happen as new case volume, deaths, and hospitalizations connected to COVID-19 have decreased
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We will also look to and follow CDC guidelines
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We will require all staff to obtain a COVID-19 vaccine once it is practical to do so
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We thank you for your understanding of these policies as we take appropriate measures to ensure that each patient receives the best, safest care possible.
Regards,
The Dental Surgery Center of DC
[2] https://phpa.health.maryland.gov/Documents/2020.11.10.04_MDH_COVID-19_Clinician_Letter.pdf
[3] https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html
[5] Ibid.
[6] Ibid.
[7] Ibid.
[8] Ibid.
[9] Ibid.
[10]
[11] Ibid.
The Decision to Stay Open
To: Healthcare Provider
From: Dental Surgery Center of DC
Date: 3/19/2020
Re: Ease Strain on Hospital Resources Amid Coronavirus Outbreak
This memo provides Dental Surgery Center of DC’s approach to reduce the strain on the hospital system during the COVID-19 crisis. The Dental Surgery Center of DC is an AAAHC licensed ambulatory surgery center and is not, and will never be a dental home. This is just in response to COVID-19.
Multiple organizations and regulators have commented that only urgent dental cases should be performed. They recommend elective procedures be postponed but cases that are likely to cause problems to the medical system (in particular if they show up to an emergency room) are recommended to be dealt with.
A temporary EMERGENCY DENTAL CLINIC is opening at the Dental Surgery Center of DC to reduce dental emergency room visits. This is not a dental office. The only procedures performed will be urgent general anesthesia cases and local anesthetic procedures limited to extractions and fillings. Pediatric and General dentists will be on staff. Our unique facility will play an important role in helping existing hospital systems deal with COVID-19 more effectively.
Emergency Dental Cases Show up at Emergency Rooms Especially When there is No Providers that are open
Emergency departments are often relied upon to evaluate and treat simple and complex dental and oral injuries (Hall, Hickey, Nguyen-Tran, and Louie 2016). Dental-related emergency department (ED) visits to hospitals have increased over the past 2 decades in the United States. (Wall et al., 2014; Lee et al., 2001; Allareddy et al., 2014; Wall et al., 2013; Wall et al., 2016) In a study conducted by the American Dental Association, more than 900,000 ED visits and nearly 13,000 hospital inpatient stays related to dental conditions were reported in the year 2009 alone (Wall et al., 2013). The study also found that the number of patient visits to hospital emergency departments doubled from 1.1 million in 2000 to 2.1 million in 2010. Common oral conditions leading to ED visits are dental caries, pulpal or periapical lesions and gingival and periodontal lesions (Rampa et al., 2017).
"The ED was families’ last resort; parents took their child to the ED because of the lack of other options in their communities rather than a belief that the ED was the best choice for dental care. The current pattern of ED use resulted in stress for these parents and repercussions for the children (e.g., pain, longer waiting, and increased complications); further, it has been shown in the literature to be an economic strain on the health system." (Haqiqi et al., 2012) Dental pain had the strongest association with ED visits. (Okunseri, et. al., 2019)
What has been recommended regarding dental cases during COVID-19
Multiple organizations and regulators have commented that only urgent dental cases should be performed. They recommend elective procedures be postponed but cases that are likely to cause problems to the medical system if they show up to an emergency room are recommended to be dealt with.
American Academy of Pediatric Dentistry
"Children in need of urgent/emergency care should be treated, while elective care can be postponed. Urgent/emergency care means treatment of pain, swelling, trauma, and infection. Hygiene and prophylaxis visits, cosmetic, and elective operative procedures should be considered non-urgent/non-emergency." March 17, 2020 (found here: https://www.aapd.org/about/about-aapd/news-room/covid-19/)
American Dental Association
“In order for dentistry to do its part to mitigate the spread of COVID-19, the ADA recommends dentists nationwide postpone elective procedures for the next three weeks. Concentrating on emergency dental care will allow us to care for our emergency patients and alleviate the burden that dental emergencies would place on hospital emergency departments.” March 16, 2020 (found here:https://www.ada.org/en/publications/ada-news/2020-archive/march/ada-recommending-dentists-postpone-elective-procedures)
Maryland State Dental Association
March 17, 2020 “The Maryland State Dental Association recommends all dental practicesvoluntarily suspend all non-essential and non-urgent dental care for at least 3 weeks.”
"We're asking every American, and our medical community leaders, and hospitals to partner with us and [delay] elective procedures across the country and our healthcare system to ensure that medical supplies and medical capacity go where they're needed," said Vice President Mike Pence, who leads administration's Coronavirus Task Force.
“The initiative has the support of the American Medical Association, according to Centers for Medicare & Medicaid Services Administrator Seema Verma, who also said the American College of Surgeons and the American Dental Association have taken a ‘proactive approach and already posted these recommendations.’” (found here: https://www.healthleadersmedia.com/clinical-care/coronavirus-gains-momentum-pence-calls-cancellation-all-elective-medical-dental)
How do Dedicated Ambulatory Surgery Centers Help?
Hospital systems are already facing limited capacity to deal with the COVID-19 health crises. The more patients they will need to triage the more stress we will put on the healthcare system. Hospital space and time will be triaged to highest risk patients, and making urgent dental cases excluded. Our facility performing emergency dental cases helps ease this burden on hospitals.
Our facility will provide a space to treat urgent dental cases allowing hospitals to dedicate resources elsewhere while avoiding cross-contamination with pediatric dental patients and COVID-19.
The threat of infection and the spread of COVID-19 is serious. We are following best practices in regard to sterilization and patient care as an AAAHC Ambulatory Surgery Center and have updated those protocols to reflect the new COVID-19 risk. Our credentialing process is swift, and we will be able to help these dentists treat their patients and avoid people showing up to the ER.
References
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Lee HH, Lewis CW, Saltzman B, Starks H. Visiting the emergency department for dental problem: Trends in utilization, 2001 to 2008. Am J Public Health 2012;102(11):e77-83.
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Wall T, Nasseh K, Vujicic M. Majority of dental-related emergency department visits lack urgency & can be diverted to dental office. Am Dental Assoc Res Brief; 2014. Available at: http://www.ada.org/w/media/ADA/Science%20and%20Research/HPI/Files/HPIBrief_0814_1.ashx.
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Allareddy V, Rampa S, Allareddy V, Nalliah RP. Hospital based emergency visits involving dental conditions: Profile and predictors of poor outcomes and resource utilization. J Am Dent Assoc 2014;145(4):331-7.
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Wall T, Nasseh K. Dental related emergency department visits on the increase in the United States. Am Dental Assoc Res Brief; 2013. Available at: http://www.ada.org/w/media/ADA/Science%20and%20Research/HPI/Files/HPIBrief_0513_1.pdf
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Wall T, Vujicic M. Emergency department Use for dental conditions continues to increase. Am Dental Assoc Res Brief; 2015. Available at: http://www.ada.org/w/media/ADA/Science%20and%20Research/HPI/Files/HPIBrief_0415_2.ashx
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Wall T and Nasseh K. Dental Related Emergency Department Visits on the Increase in the United States (American Dental Association, May 2013).
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Rampa, Sankeerth, Fernando A. Wilson, Hongmei Wang, Nizar K. Wehbi, Lynette Smith, and Veerasathpurush Allareddy. "Hospital-Based Emergency Department Visits With Dental Conditions: Impact of the Medicaid Reimbursement Fee for Dental Services in New York State, 2009-2013." Journal of Evidence Based Dental Practice 18, no. 2 (2018): 119-129.
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Okunseri, Christopher, Stephanie Zbin, Cheng Zheng, Frederick Eichmiller, Elaye Okunseri, and Aniko Szabo. "Emergency department visits and dental procedures: Mission of Mercy, 2013–2016." Clinical, cosmetic and investigational dentistry 11 (2019): 157.
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Hall, Emily, Patricia Hickey, Thuy Nguyen-Tran, and Jeff Louie. "Dental trauma in a pediatric emergency department referral center." Pediatric emergency care 32, no. 12 (2016): 823-826.
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Nagarkar, Sanket R., Jayanth V. Kumar, and Mark E. Moss. "Early childhood caries–related visits to emergency departments and ambulatory surgery facilities and associated charges in New York state." The Journal of the American Dental Association 143, no. 1 (2012): 59-65.
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Mostajer Haqiqi, Azadeh, Christophe Bedos, and Mary Ellen Macdonald. "The emergency department as a ‘last resort’: why parents seek care for their child's nontraumatic dental problems in the emergency room." Community dentistry and oral epidemiology 44, no. 5 (2016): 493-503.
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