Emma Hammett RGN, CEO of First Aid for Life, provides a guide for BDJ Team readers.

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Coronavirus, COVID-19 is here. It is highly contagious and potentially lethal for many. Consequently (at the time of writing) routine dental treatment is no longer being offered in dental practices. Regular updates are published on the General Dental Council's website (www.gdc-uk.org).

All dental practices should establish (independently or by collaboration with others) a remote urgent care service, providing telephone triage for their patients with urgent needs during usual working hours, and whenever possible treating with:

  • Advice

  • Analgesia

  • Antimicrobial means where appropriate.

If the patient's condition cannot be managed by these means, then they will need to be referred to the appropriate part of their Local Urgent Dental Care system.

The GDC request that all dental practices:

  • Update their messaging and websites

  • Contact their regional commissioner should practice availability hours alter as a result of staffing levels

  • Inform the commissioner of these changes and the arrangements for cover.

Your regional commissioner will then inform the Directory of Services (DOS) lead so that 111 are up to date with the correct information.

What you need to know

  • Front line dental staff treating patients face to face should wear appropriate personal protective equipment (PPE)

  • Everyone is encouraged to limit contact with other people other than for essential reasons

  • People should stay at home if they are unwell with a new, continuous cough or a high temperature to avoid spreading infection to others

  • All patients should be screened over the telephone to establish if they may have a higher risk of having contracted COVID-19

  • Clean and disinfect regularly touched objects and surfaces more often than usual. This can be done using your standard cleaning products

  • Regular and thorough hand washing is critical. It is also vital to regularly change gloves and dispose of them carefully

  • Be careful how you put on medical masks and remove them (https://bit.ly/2wgswaU). Ensure you do not contaminate yourselves, or others in the process

  • Always catch coughs and sneezes in tissues and flush them away

  • Ensure you have sufficient first aid provision in your practice. Some first aid training companies are able to offer online and remote 1:1 assessment as interim qualifications to help you at this extremely difficult time.

If you suspect someone may have COVID-19

If someone appears unwell with possible COVID-19 symptoms, they should leave the premises immediately and be encouraged to go home avoiding public transport and other people.

Should they need to be collected, they should ideally be moved to a room where they can be isolated behind a closed door. If it is not possible to isolate them, move them to an area which is at least two metres away from other people.

If they need to go to the bathroom while waiting to be collected, they should use a separate bathroom if possible. The bathroom should be cleaned and disinfected using standard cleaning products before being used by anyone else.

If they need clinical advice, they should go online to NHS 111 (https://111.nhs.uk/) (or call 111 if they don't have internet access). In an emergency, call 999 if they are seriously ill or injured or their life is at risk. Do not visit the GP, pharmacy, urgent care centre or a hospital. Ensure that health professionals are aware that you suspect COVID-19.

If a member of staff has helped someone who you suspect may have developed COVID-19, they do not need to go home unless they develop symptoms themselves. They should wash their hands thoroughly for 20 seconds after any contact with someone who is unwell.

If there is a requirement for urgent public health action, the educational setting will be contacted by the local Public Health England Health Protection Team who will undertake a risk assessment and advise on any actions or precautions that should be taken.

Hygiene and prevention

There is currently no vaccine to prevent coronavirus disease 2019 (COVID-19). If you are working in close contact with other people in a dental setting, you should wear appropriate PPE.

The best way to prevent illness is to avoid being exposed to the virus.

The virus is thought to spread mainly from person-to-person:

  • Between people who are in close contact with one another (within about two metres), for in excess of 15 minutes

  • Through contamination from respiratory droplets produced when an infected person coughs or sneezes. These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs.

Older adults and people who have severe underlying chronic medical conditions like heart or lung disease or diabetes and immunocompromised patients, seem to be at higher risk for developing more serious complications from COVID-19 illness. It is vital we protect them from being infected by the virus.

Take steps to protect yourself and your patients

Clean your hands often and teach the children in your care how to wash their hands properly too (Fig. 1):

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How to wash your hands

Full size image

  • Wash your hands thoroughly and frequently with soap and water for at least 20 seconds, especially after you have been in a public place, or after blowing your nose, coughing, or sneezing. Dispose of used tissues in yellow bag or down the toilet

  • If soap and water are not readily available, use a hand sanitiser that contains at least 60% alcohol. Cover all surfaces of your hands and rub them together until they feel dry

  • When wearing gloves, wash your hands before putting them on. Dispose of work gloves extremely carefully and wash your hands once more

  • Avoid touching your eyes, nose, and mouth with unwashed hands

  • Always wash your hands before eating and drinking

  • Avoid close contact with people who are sick

  • Where possible, put at least a two metre distance between yourself and other people.

Clean and disinfect:

  • Clean AND disinfect daily. This includes tables, doorknobs, light switches, countertops, handles, desks, phones, keyboards, toilets, taps and sinks

  • If surfaces are dirty, clean them: use detergent or soap and water prior to disinfection.

Primary Care Support England (PCSE) (https://pcse.england.nhs.uk/) are working with NHS England to support dentists. PCSE are prioritising the fulfilment and delivery of supplies and ensuring that performers are on the list and able to provide services to the NHS.

Public Health England has a dedicated webpage with a range of posters and digital materials (https://bit.ly/2JFMpuW). There is guidance from Public Health England about decontamination of settings (https://bit.ly/3dVuBtV) where a possible or confirmed COVID-19 case has spent time while symptomatic.

If you become ill:

  • If you have a new persistent cough or fever above 37.8, you should self-isolate for seven days. During this time, you are particularly contagious

  • You no longer need to be tested for the virus; only those requiring hospital treatment will be tested

  • Only phone 111 if you become substantially worse, need medical help for another health condition or if you get further symptoms after five days

  • Use the 111 online service (https://111.nhs.uk/) for further guidance

  • Stay at home, rest and drink plenty of fluids. Take painkillers if necessary and you should feel better in 5-7 days. If you are concerned you are getting worse or have another serious medical issue, phone 111.

For further guidance on how to help if you are ill visit: https://firstaidforlife.org.uk/coronavirus-recovery/.

It is strongly advised that you attend a fully regulated practical or online first aid course to understand what to do in a medical emergency. Visit https://firstaidforlife.org.uk or call 020 8675 4036 for more information about First Aid for Life's courses.

First Aid for Life's trainers are highly experienced medical, health and emergency services professionals who will tailor the training to your needs.

First Aid for life provides this information for guidance and it is not in any way a substitute for medical advice. First Aid for Life is not responsible or liable for any diagnosis made, or actions taken based on this information.

This article was written at the end of March 2020.