Clarification on IPC Guidance

During the past two years the dental profession has been provided with two regular update publications to assist in safely managing access and care.

These complementary reference documents have offered advice/guidance to dental practices on prioritisation of care and clinical capacity (NHS Dental SOPs) and protection of patients, public and staff (UKHSA IPC - Dental Appendix).

The first of these publications, the NHS Dental SOP was archived on 5 April 2022.

As at 11 May 2022 the UKHSA IPC Guidance and the Dental Appendix supporting risk management in primary dental care settings remains in place as your reference guidance, albeit with some revisions which we have detailed below. https://www.gov.uk/government/publications/wuhan-novel-coronavirus-infection-prevention-and-control/covid-19-infection-prevention-and-control-dental-appendix.

In a recent letter NHS England and NHS Improvement outlined changes to UK Health Security Agency (UKHSA) guidance on infection prevention and control (IPC).

https://www.england.nhs.uk/wp-content/uploads/2019/03/C1630_Next-steps-on-IPC-Publication-of-revised-UK-Infection-Prevention-and-Control-IPC-Guidance-and-an-IPC-Man.pdf 

The recently revised sections of the overarching UK HSA IPC guidance equally apply to the primary dental care setting, with effect 15 Apr 2022

What does this mean for your practice?:

Returning to pre-pandemic physical distancing in primary care, inpatient and outpatient settings.

The recently published UK Health Security Agency advice removes the requirement for physical distancing in patient waiting areas where no risk has been identified.

This is applicable in dental practice settings but should be done in a way that continues to maintain compliance with all relevant Health Technical Memoranda (HTM) and Health Building Notes. Example:

• Communal areas free from clutter and any unnecessary items.
• Communal areas should be well ventilated
• Face coverings - Practices should continue to use face masks (staff) and face masks/coverings by visitors and patients where clinically tolerated

Returning to pre-pandemic cleaning protocols outside of COVID-19 areas, with enhanced cleaning only required in areas where patients with suspected or known infection are being managed

What hasn't changed?:

Face coverings - practices should continue to use face masks (staff) and face masks/coverings by visitors and patients where clinically tolerated.

Screening:

There remains a continuing requirement for screening and the adoption of risk assessed IPC measures when treating dental patients in clinical care settings:

The main benefit of screening, is that in the event of a "yes" to any of the questions posed, a more informed consideration may be given to risk management and IPC/PPE requirements.

The legacy example screening questions on the UKHSA website were offered as a guide to practices in framing their approach to screening. Pending publication of further examples and/or advice practices may wish to consider a pragmatic approach in framing the screening questions for patients. The four key areas of enquiry are:

Signs and Symptoms of a Respiratory Infection:

The advice to screen out unwell patients with obvious respiratory infection and defer dental care unless urgent remains.

Patient reported symptoms and signs of a respiratory infection should be noted and a risk assessment prior to commencing/deferring treatment, especially treatment involving AGP, is necessary.

Example Question : "Are you suffering with any symptoms that may indicate a respiratory infection?".

If yes, apply TBPs or if treatment can be deferred, reschedule providing this is not detrimental to patient care/treatment plan

Confirmed COVID-19 Diagnosis:

Practices are advised to enquire as to any recent COVID infections or recent positive test.

Some members of the public are still testing and healthcare workers are testing twice a week, the numbers answering "yes" are likely to be low'

Where a household member has been confirmed as COVID+ in the last 10 days transmission of infection is a risk to be managed.

Example Question: "Have you or any member of your household/family had a confirmed diagnosis of COVID-19 in the last 10 days?"

If yes, apply TBPs or if treatment can be deferred, reschedule providing this is not detrimental to patient care/treatment plan

Patients Isolating:

There is currently no legal requirement to isolate, however some patients and/or members of their household/family may have been advised to isolate by an NHS organisation in the last 10 days".

Example Question: "Have you or any member of your household/family been advised to isolate by any NHS organisation in the last 10 days?

If yes, apply TBPs or if treatment can be deferred, reschedule providing this is not detrimental to patient care/treatment

Travel from High Risk locations:

There are currently no red list restrictions in place for travel to England. Whilst the Government "red list" is empty practices may choose to omit the travel question until such time as the situation changes. Details of the lists are at (https://www.gov.uk/guidance/travel-to-england-from-another-country-during-coronavirus-covid-19)

Risk Management based on Screening Responses

Patients answering 'no' to all screening questions, and with no clinical signs or symptoms of respiratory infection only require the application of standard infection control precautions (SICPs) at the point of care.

Patients answering 'yes', to any one of the screening questions, should to be assigned to the respiratory pathway (as detailed in Section 2 of the UKHSA dental appendix). Practices should apply TBPs in addition to SICPs or if treatment can be deferred, reschedule providing this is not detrimental to patient care/treatment . For patients on the respiratory pathway undergoing aerosol generating procedures (AGPs), post AGP downtime applies.

Further information: In supporting your transition to the "new normal" practices are encouraged to consider the guidance in the recently published NHS England IPC Manual, https://www.england.nhs.uk/publication/national-infection-prevention-and-control/ .

Where practices require further advice they may wish to consult with their regional leads for any bespoke practice advice:

• Regional Dental Public Health consultant
• Regional NHS IPC lead