Zero Seven Dental Practice Return to work letter

Dear Patient,

How are you? We do hope that you and your loved ones have stayed well and healthy and that you have remained relatively unscathed by this devastating Coronavirus pandemic. We hope you did not suffer the loss of a loved one and if you did then our heartfelt condolences to you. We do hope the last two months perhaps gave everyone time to reflect on their lives, catch up with old friends and family albeit via telecommunications and possibly even take up new hobbies or decided to change careers altogether. I know I certainly toiled with the last option as the dental industry was plunged into serious turmoil and unfortunately the profession received very limited help from the government. Then again most industries were severely affected and after a few days of staring into the abyss, our team came together to put into action our return to work plan. We all researched papers, attended webinars and engaged on social media platforms with dentists worldwide to look deeply into the virus and its implications for the future provision of dental health. The nationwide lockdown was a necessary tool at the time in reducing the spread of the virus and rate of infections and ultimately deaths. These rates are now thankfully slowing down and the government is starting to ease lockdown. We are moving towards a new ‘normal’, hence why we are writing to inform you of our imminent return to work on Monday 8th June 2020.

We know from all the vast media coverage of the pandemic that there were many possible modes of transmission of the Covid virus:

Primary transmission between people: respiratory droplets and contact routes
Direct contact with infected people
Indirect contact with surfaces in the immediate environment
Objects used on infected person
Airborne transmission may be possible: specific circumstances through procedures that generate aerosols (AGP)
The disease could be transmitted directly or indirectly through saliva

The information conveyed was frightening to say the least and left most patients fearful of attending the dental practice during the pandemic.

Whilst we acknowledge that there may be a risk of transmission via aerosol, most of the literature and studies carried out have shown that there were relatively low rates of infection within the dental community. In fact the rate of infection of dental staff was lower than the population indicating that our already high infection protocols and standards had adequately prevented transmission of the virus within the surgery settings and any transmission to dental staff was most likely attributable to general community spread outside of the dental surgery.

We completely understand the anxiety that patients (particularly those who are elderly, shielded or vulnerable) may feel on returning to have routine dental treatment.

Let me assure you that we at Zero Seven Dental are doing the very best to look after you. We have carried out a thorough risk assessment, enhanced our working protocols and invested heavily in new technologies to significantly reduce potential aerosol transmission in order for us to protect our patients and staff and to be able to carry out routine daily treatment.

We have invested in:

Isovac High Volume Suction units that remove 90% of aerosol at source. Click here to see video
Prestige EXSS extra oral suction units to further remove aerosol close to the source. Click here to see video
RADIC8 Viruskiller 401 and HEXTIO units to purify the air and remove 99.99% of pathogens, pollution and most importantly viruses from the air. VK Blue by Radic8
In order to prevent cross contamination in reception, we are creating a contactless journey for our patients. We are moving all form filling, contact information, medical history updating, treatment plans and consent form signing onto online patient portals all via your phone or tablets. We are also changing the way we take future payments. We will be providing our bank details to all patients wishing to set up direct online payments, or payment can be taken over the phone prior to your appointments. We are trying to avoid use of the card terminal as much as possible.
We already use digital technology to construct crowns and veneers in house by means of the CEREC 3D CAD CAM and are now also moving onto digital impressions for all future dentistry including Invisalign treatments. We are also going to provide tele-dentistry where we can offer remote check ups and assessments for the our elderly and more vulnerable patients.

With these five technological advancements, along with barrier screens at the reception desk and additional enhanced personal protection equipment (PPE), we at Zero Seven Dental have significantly mitigated the risks of transmission of any virus.

Obviously whilst we are still in the recovery phase and there is a potential for a second wave of infections, we cannot return to normal working patterns and instead will be carrying out treatment in a highly structured way so as to minimise all possible modes of transmission. This unfortunately means we will be seeing less patients per day and giving more time per appointments in order to carry out thorough disinfection of the surgeries between patients. We will be staggering our opening times and extending working hours to try and accommodate as many of you as possible. Ruth our hygienist will be giving us an extra day a week as well as her brother Dr John Alton, thereby increasing our capacity to accommodate you. We will also be opening occasional Saturdays (by appointment only) to accommodate our more vulnerable and elderly patients. Our first week back will be mainly spent treating and stabilising emergencies that have built up over the last two months. There is still great uncertainty as to when we can resume a full normal service and as yet, may not be able to do so for another few weeks as we follow the government guidelines and alert levels.

We will be carefully triaging patients prior to booking appointments and there will be a protocol for patients to follow when they attend the practice. Please refer to appendix 1.

We will be staggering appointments so that we maintain social distancing rules. There will be only a maximum of two patients allowed in the surgery premises at any given time. As such

I ask you all for your understanding and patience with regards to bookings. Whilst we are having to adopt new infection protocols, it may be that the surgery turnaround time prevents us from booking routine examinations and hygiene appointments on the same day. Although we will be adding further hygiene sessions in the week, we unfortunately cannot guarantee that your examination and hygiene appointments can be carried out sequentially.

We apologise in advance for any inconvenience caused. Please understand we are doing this to be able to attend to your dental needs whilst respecting all patients needs to maintain their own health and safety. These measures will not be indefinite but may need to continue for several months following government guidelines and changes in their latest alert level measures.

As most of our patients prebook their six monthly examinations and hygiene appointments, some patients will already have those appointments in the diary. We will contact you in advance to let you know if we can still accommodate you, but we may have to, or you may choose to rearrange for a more convenient time. Our phone lines will be open from 9am on Thursday 4th June, two days before we start seeing clients on Monday 8th June. Preference will be given to patients who have had emergencies and those who are in the middle of treatments that cannot await further delay, to be seen and treated in that first week.

Every system we have put in place has been to safeguard both patients and staff alike and allow us to continue treating with the fullest confidence and knowledge that we are always looking after you. We have been previously assessed by both Care Quality Commission (CQC) and the British Dental Association (BDA) Good Practice Scheme and our infections control measures and policies have been checked and approved to be of the highest standards and we continue to maintain this.

We hope you take comfort from this letter and feel confident that whilst you are attending our dental practice you will be in the safest of environments.

We look forward to seeing you all again very soon, catching up with your lockdown stories and regain the smiles and laughter that emanated from our surgeries.

Appendix 1

Patients journey

Bookings can take place via telephone or online. You will be asked either by online form or in person over the phone the following:

Reception Triage questions:

a) Has the patient had Covid -19

b) Have you experienced symptoms, such as:

the sudden onset of fever, (temperature> 37.5o)
cough
sore throat and
shortness of breath?
Loss of smell and taste

• Common: fever, tiredness, and dry cough.

• Some patients: Aches, pains, runny nose, nasal congestion, sore throat, diarrhoea.

• Severe cases: pneumonia, severe acute respiratory syndrome, sometimes death.

• NOTE: Some patients have no symptoms

c) Have you had contact with anyone with confirmed COVID-19 infection in the last 14 days?

d) Identification of group status (e.g. elderly, vulnerable or shielding)

When booking appointment

Instruct all patients to do the following:

Shower and change clothes prior to attending
Brush teeth prior to attending
Attend alone unless they require a carer/guardian
Travel light, patients will be asked not to bring unnecessary belongings with them, essentials must be placed on a surface or in a container which can be disinfected or disposed of between patients.
To go to the toilet before they come for their appointment. This is to try and limit the use of our facilities. Please bear in mind the toilet will need to be cleaned and disinfected after each patient use and this may cause further delays between appointments for other patients.

All staff will be conscious that patients may be apprehensive, especially when we depart form standard procedures. Time will be taken to explain anything expected of them in advance. If a patient fails to comply with any instructions, then we may consider refusing treatment, on the basis that all steps are necessary to reduce risk of potential COVID-19 transmission to staff and other patients. All instructions are available in written format and any policies available for patients who wish to request a copy.

When patient arrives

On arrival the patient is asked to:

Wash hands or use hand sanitiser
Wear a mask while in the waiting area
Undergo a mandatory temperature check
We ask that you try and keep on time for your appointments. If you arrive too early or late we may not be able to let you into the reception area and there may be a slight waiting period in the hallway.
Patients will be asked to rinse with 1.5% hydrogen peroxide for 30 seconds prior to the commencement of treatment

When patient leaves

On leaving the patient is again to:

Rinse with 1.5% hydrogen peroxide for 30 seconds prior to the leaving the treatment room.
Wash hands or use hand sanitiser
Wear a mask while in the waiting room.

Door handles and any potential patient contact areas and floors are cleaned and disinfected after patient leaves the practice.

Appendix 2

Zero Seven Dental Practice Standard Operating Procedure policy during Covid 19 Pandemic available on request from the practice.