COVID-19 CDC & PPE
CDC COVID-19 Recommendations and Guidelines
April 16, 2020: ADA Issues Interim Fask and Mask Shield Guidelines
You may review the full document here.
April 9, 2020: IDPH Issues PPE Shortage Order
You may review the IDPH PPE Shortage Order here.
April 7, 2020: CDC Updates Interim Infection Prevention and Control Guidance for Dental Settings during the COVID-19 Response
Revisions were made on April 7, 2020
- Description of risk to dental health care personnel (DHCP)1 when providing emergency care during the COVID-19 pandemic.
- Recommendations for contacting patients prior to emergency dental care.
- Recommendations for providing emergency dental care to non-COVID-19 patients including engineering controls, work practices and infection control considerations.
- Potential exposure guidance.
- Contingency and crisis planning.
To review the full details of the interim guidance, please visit https://www.cdc.gov/coronavirus/2019-ncov/hcp/dental-settings.html.
March 27, 2020: CDC Recommendations for Practice in Dental Settings
The Centers for Disease Control and Prevention updated recommendations for practice in dental settings on March 26, 2020. To review the updated recommendations, please visit https://www.cdc.gov/coronavirus/2019-ncov/hcp/dental-settings.html.
March 23, 2020: The CDC has issued recommendations for Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings. The recommendations provide information about how to limit germs entering a facility, the isolation of symptomatic patients, and how to protect healthcare personnel.
Key Concepts in This Guidance
- Limit how germs can enter the facility. Cancel elective procedures, use telemedicine when possible, limit points of entry and manage visitors, screen patients for respiratory symptoms, encourage patient respiratory hygiene using alternatives to facemasks (e.g., tissues to cover cough).
- Isolate symptomatic patients as soon as possible. Set up separate, well-ventilated triage areas, place patients with suspected or confirmed COVID-19 in private rooms with door closed and private bathroom (as possible), prioritize AIIRs for patients undergoing aerosol-generating procedures.
- Protect healthcare personnel. Emphasize hand hygiene, install barriers to limit contact with patients at triage, cohort COVID-19 patients, limit the numbers of staff providing their care, prioritize respirators and AIIRs for aerosol-generating procedures, implement PPE optimization strategies to extend supplies.
The CDC recommends the use of telemedicine/teledentistry when possible. Healthcare providers may use audio and video technology to communicate with patients to determine when in-person care may be required. The Office of Civil Rights (OCR) at the Department of Health and Human Services (HHS) has stated that they will not impose penalties for the use of technology that may not otherwise be HIPAA compliant during the COVID-19 crisis. For more information about the statement issued by the OCR, please see https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/notification-enforcement-discretion-telehealth/index.html.
March 20, 2020: The CDC Division of Oral Health reiterated the CDC's recommendation that dental facilities postpone until further notice elective procedures, surgeries and non-urgent dental visits. The CDC's recommendation echos the recommendation made by the American Dental Association and the Centers for Medicare and Medicaid Services (CMS). Postponing elective and non-urgent dental procedures serves to protect staff and preserve PPE. The urgency and need for dental procedures should be based on clinical judgment and made on a case-by-case basis.
The CDC's Division of Oral Health is working with the CDC's Emergency Operations Center to develop COVID-19 recommendations specifically for dental settings. The Iowa Dental Board will post the information here when it becomes available.
The CDC's Division of Oral Health also recommends that dental healthcare personnel consider signing up for communications from the CDC's Health Alert Network.
The Centers for Disease Control and Prevention is developing guidance regarding the response to COVID-19 in dental settings. The CDC has currently issued the following precautions and guidelines:
Standard precautions, including the use of proper personal protective equipment, should be followed when caring for any patient. These practices are designed to both protect DHCP and prevent DHCP from spreading infections among patients.
CDC’s guidelines note that, if not clinically urgent, DHCP should consider postponing non-emergency or elective dental procedures in patients who have signs or symptoms of respiratory illness. For procedures which are considered clinically urgent, dental health care personnel and medical providers should work together to determine an appropriate facility for treatment. The urgency of a procedure is a decision based on clinical judgement and should be made on a case-by-case basis.
The full statement from the CDC is available at https://www.cdc.gov/oralhealth/infectioncontrol/statement-COVID.html. The Iowa Dental Board will forward additional information and recommendations from the CDC as it applies to practice in dental settings as it becomes available.
Personal Protective Equipment (PPE) Recommendations and Guidelines
March 24, 2020: CDC Strategies for Optimizing the Supply of PPE: https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/index.html
March 23, 2020: CDC Strategies for Optimizing the Supply of Facemasks.
The CDC references three levels of capacity:
- Conventional capacity
- Contingency capacity
- Crisis capacity
Contingency Capacity Strategies
During contingency capacity, health care professionals may need to implement extended use of facemasks. During extended use, the same facemask may be worn with different patients. The CDC recommends removal and disposal of the facemask if it becomes soiled, damaged or difficult to breathe through. If a healthcare professional touches or adjusts the facemask, they must immediately wash their hands. Additionally, the health care professional should leave the patient care area if the facemask needs to be removed.
Crisis Capacity Strategies
During crisis capacity, the CDC recommends canceling all elective and non-urgent procedures and appointments for which a facemask would typically be used. The CDC also recommends limited re-use of facemasks. The CDC defines limited re-use of facemasks and makes recommendations as follows:
Limited re-use of facemasks is the practice of using the same facemask by one HCP for multiple encounters with different patients but removing it after each encounter. As it is unknown what the potential contribution of contact transmission is for SARS-CoV-2, care should be taken to ensure that HCP do not touch outer surfaces of the mask during care, and that mask removal and replacement be done in a careful and deliberate manner.
- The facemask should be removed and discarded if soiled, damaged, or hard to breathe through.
- Not all facemasks can be re-used.
- Facemasks that fasten to the provider via ties may not be able to be undone without tearing and should be considered only for extended use, rather than re-use.
- Facemasks with elastic ear hooks may be more suitable for re-use.
- HCP should leave patient care area if they need to remove the facemask. Facemasks should be carefully folded so that the outer surface is held inward and against itself to reduce contact with the outer surface during storage. The folded mask can be stored between uses in a clean sealable paper bag or breathable container.
The use of facemasks should be prioritized for select activities such as:
- Essential surgery and procedures;
- Activities that may generate splash or spray;
- During prolonged face-to-face contact or close contact with an infectious patient;
- For performing aerosol-producing procedures if respirators are no longer available.
The CDC has also offered recommendations for situations where facemasks may no longer be available. Review more detailed information regarding the CDC's Strategies for Optimizing the Supply of Facemasks here.
Donations of PPE
The Iowa Department of Public Health is encouraging Iowa business and organizations to donate extra personal protective equipment (PPE) to assist health care providers and health care facilities in responding to COVID-19. You may read a full copy of the press release here for further information.