2021, Number 2
Protocol of the health services in a dental clinic during the COVID-19
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ABSTRACT
In December 2019, the presence of atypical pneumonia was reported in the city of Wuhan, China; in which January fines the World Health Organization would declare the outbreak of the new coronavirus a national emergency. Faced with this health emergency, dental practice has found it necessary to undergo modifications in order to adapt to the new normal. From the very beginning, the Cuban medical care directorate dictated a series of measures that required the organization of oral health services, which they will receive in each stomatological center. The objective of this work is to describe the necessary measures for the "51 and 86" Stomatological Clinic, as well as their compliance with this pandemic. This protocol was based on the priority attention to dental emergencies, the training of personnel, their distribution in different tasks and the reinforcement of biosafety measures.INTRODUCTION
In December 2019, atypical pneumonia was reported to the World Health Organization (WHO) offices in China in Wuhan City, Hubei Province. In January 2020, the causative agent, SARS-CoV-2 coronavirus (Severe Acute Respiratory Syndrome Coronavirus 2), was isolated. On January 30, 2020, WHO reported this outbreak as a "public health emergency of international concern", naming the disease COVID-19.1
In a short period COVID-19 spread from Asia, Europe, America and finally throughout the world;2 reporting to date (February 8, 2021) a total of 190 countries and 29 territories, amounting to 106'891,642 confirmed cases, according to statistics from the official website of the Ministry of Public Health of Cuba (MINSAP).3
The WHO decreed the situation as a pandemic and with this postulate, each State enacted specific regulations to mitigate the risk of contagion and take care of the economic and social aspects.4
Cuba has been prepared to face the pandemic caused by the new coronavirus. Since the first cases were confirmed in the country (March 11, 2020), MINSAP implemented an intersectoral plan developed two months earlier together with the Civil Defense.5,6 This plan, called Plan de Enfrentamiento a la COVID-19, established among the main priorities the strengthening of national epidemiological surveillance, which is based in the health services network of the first level of care. In this plan, a comprehensive management model has been designed, with three components that include: epidemiological management, organization of health services for preventive care and case management, as well as the contributions of science and biotechnology.6
The appearance of SARS-CoV-2 marked the beginning of the largest virus infection prevention campaign in the history of mankind. Country after country, territory after territory, the virus is advancing and forcing the adoption of extreme measures such as social isolation.7
Several dental associations around the world recommended, or even forced, dentists to postpone elective procedures on March 16, 2020. In England, it was communicated on March 25 that all non-urgent routine dental care, including orthodontics, should be suspended and deferred until otherwise indicated. Centers for Disease Control and Prevention in the United States, recommended on March 27 that, to protect personnel and preserve personal protective equipment and patient care supplies, dental facilities should postpone elective procedures, surgeries, and non-urgent dental visits.8
Facing this health emergency, dental practice has had to undergo modifications to adapt to the new normal. From the very beginning, the Cuban health care management dictated a series of measures specifying the organization of oral health services to be adopted in each stomatological center. The objective of the present work is to describe the measures adopted by the Stomatological Clinic "51 y 86", as well as their compliance with these measures in the face of this pandemic.
MATERIAL AND METHODS
A descriptive study was carried out with the aim of evaluating the measures adopted by the "51 y 86" Stomatological Clinic in the months of March 2020 to January 2021. Interviews with directors and part of the institution's working staff were used as a resource to obtain information, with prior informed consent and respecting the principles of confidentiality and privacy of information. The interview was focused according to the measures oriented by the Cuban health care management to each health center. The topics of the questions were: organization of health services, training of work personnel, COVID-19 surveillance system and biosecurity measures. The information was collected by recording and later transcribed.
RESULTS
Organization of oral health servicesIn view of the new measures decreed and their subsequent analysis and adaptation to the center, the directors and heads of department (those most responsible for their compliance) gave priority attention to procedures considered to be stomatological emergencies, such as: dental, facial and post-traumatic pain, acute inflammatory dental and oral-maxillofacial processes and oral-dental trauma.
Priority attention was given to children and young people under 19 years of age, pregnant women and mothers with children under one year of age, the disabled, as well as treatments that may put patients' lives at risk and cause sequelae. The order of priority of each patient was established by the admission and filing department in conjunction with the stomatologists and service chiefs, who were in charge of classifying them according to the health problem they presented.
There were only two stomatologists and their assistants in the primary care service, where a dental unit was assigned for the care of pregnant women and children under 19 years of age, and another unit for emergency care. Young, healthy personnel were selected to perform these tasks.
The entrance of accompanying people to the clinic was prohibited, with the exception of children and handicapped patients. The waiting room was rearranged in such a way that a distance of one and a half meters was maintained between patients. The ingestion of food inside the clinic was prohibited. Magazines, folders and other materials that could constitute routes of transmission of the disease were removed from both the waiting room and the patient care area.
Action taken with each patientEach patient was considered a possible carrier of the virus, and action was taken accordingly. Epidemiological surveillance was established for each patient attended; a series of questions related to the risk of exposure to COVID-19 were included in the interrogation, which were recorded in the patient's medical records. These questions were as follows:
- 1. Were you out of the country?
- 2. Have you had any contact with a person from abroad in the last two weeks?
- 3. Have you had contact with any person who was later placed in isolation or diagnosed with the disease?
- 4. Do they have any signs or symptoms of illness associated with COVID-19 (fever, runny nose, loss of smell, diarrhea, cough, headache, malaise or other)?
- 5. How many days since the same?
Each patient was informed about the clinic's new monitoring protocol, the importance of discipline and compliance.
Clinic staffAll clinic personnel were constantly trained with updated scientific information on COVID-19, and were informed about the new measures to be implemented and the importance of complying with them due to the occupational risk to which they are exposed.
They were instructed to carry out epidemiological surveillance actions in the communities that corresponded to their family offices, maintaining at all times the general biosecurity measures (mask, face shield, sanitary gown, overcoat, 0.1% hypochlorite solution or alcoholic solution for hand disinfection). All stomatologists and assistants worked together with the office nurse and physician.
In case of illness or infection by coronavirus of any worker, the only way to return to the workplace was to provide a medical discharge certificate.
Biosecurity measuresAt the entrance to the clinic, a mat moistened with 1.5% sodium hypochlorite was placed for cleaning shoes, an alcohol dispenser was placed for hand disinfection, and the data of all persons entering the clinic were recorded, as well as the temperature.
As for clothing, the use of medical pajamas was prohibited in the institution. Long-sleeved gowns were used as a sanitary uniform and, in patient care, an overcoat was also to be worn. The correct use of masks for both patients and staff was mandatory.
Each stomatologist also had to wear a face shield, a cap per shift, a pair of gloves per patient, N-95, FFP2 masks or, failing that, double disposable nasobuccal masks; while dental assistance and prosthesis technicians had to wear a mask, face shield, cap per shift and gloves per patient.
It was mandatory to clean the center with 0.5% sodium hypochlorite after each working day. The cleaning personnel were provided with a mask, high resistance gloves, sanitary gown and overcoat for use in high-risk areas.
The decontamination of the dental sets was carried out by the dental technicians or assistants, who applied 0.5% sodium hypochlorite solution after each patient treatment was completed.
Hand washing protocol with soap and running water was strictly enforced. The use of towels for drying hands was prohibited, and disposable paper towels were used. The hand washing and disinfection procedure was carried out before and after the physical examination of each patient, as well as the handling of personal protective equipment.
Containers were set up for contaminated waste, which were required to have a lid with a pedal for opening. Care was taken to ensure their collection, avoiding the accumulation of waste, especially in high-risk areas.
Secondary careProsthesis consultations were cancelled, only attending emergency cases due to breakage or defects of the same. As for orthodontics and periodontics, its operation depended on the epidemiological conditions in which the country found itself; where its schedule of appointments and programming were established by the administration and archives department. Said agenda was planned maintaining a staggered schedule, where patients were summoned from the same institution.
The new stage in which dentistry is living has been a challenge to be faced by all health professionals. Applying and adapting to the new changes will be the main objective proposed by the dental clinic.
CONCLUSIONS
The stomatological clinic was immersed in the adoption of a strict protocol for dealing with COVID-19. The prioritized attention to dental emergencies, the training of personnel, their distribution in different tasks and the reinforcement of biosecurity measures were the basis of this protocol, which was carried out with great effectiveness.
REFERENCES
Redacción Digital. Ministerio de Salud Pública: Tres turistas italianos con coronavirus son los primeros casos reportados en Cuba. Granma-Órgano Oficial del Partido Comunista de Cuba. 2021. Disponible en: https://www.granma.cu/cuba-covid-19/2020-03-11/nota-informativa-del-ministerio-de-salud-publica-tres-turistas-en-cuba-resultaron-positivos-al-nuevo-coronavirus
AFFILIATIONS
1 Clínica Estomatológica "51 y 86". La Habana, Cuba.
2 Residente de primer año de Estomatología General Integral.
3 MSc en Urgencias Estomatológicas. Especialista en Cirugía Maxilofacial.
CORRESPONDENCE
Jorge Enrique Valledor Alvarez. E-mail: jorvalle96@gmail.comReceived: Febrero 2019. Accepted: Marzo 2019.