scholarly journals Aerosol-generating Procedures and Decision Drivers for COVID Pre-procedure Testing

2021 ◽  
Vol 5 (6) ◽  
Author(s):  
Sam Wakim ◽  
Dovid Friedman ◽  
Eva Turbiner ◽  
Shmuel Halpert ◽  
Jeffrey Kaminetzky ◽  
...  
Keyword(s):  
Close Contact ◽  
Healthcare Providers ◽  
Dental Services ◽  
Process Improvements ◽  
Dental Patients ◽  
Asymptomatic Patients ◽  
Dental Procedures ◽  
Dental Staff ◽  
Effective Delivery ◽  
Asymptomatic Individuals

Introduction: SARS-CoV-2 is thought to spread between individuals in close contact, primarily through respiratory droplets, including asymptomatic individuals [1,2]. The virus has been shown to persist in aerosols for hours [3]. Aerosol-generating procedures may increase the risk of transmission to healthcare providers, potentially putting dentists and patients at greater risk of exposure [3]. Current CDC guidelines for dental professionals include: N95 or higher-level respirator use during aerosol-generating procedures; COVID screening and triaging of patients; hand and respiratory hygiene best practices; facility updates; and physical distancing. The CDC also recommends considering pre-procedure testing to identify pre- and asymptomatic patients [2]. Methods: In June 2020, New Jersey health centers Zufall Health and CHEMED implemented COVID-19 testing prior to aerosol-generating dental procedures, along with other protocols, as part of the safe reopening of their facilities. They utilized screening and testing to safeguard dental staff and patients, to calm anxious front-line employees, and to facilitate patient follow-through on dental care. In September 2020, the centers undertook additional process improvements to determine the continued viability of pre-procedure COVID testing in their dental facilities. Results: From September 2020 to March 2021, the centers found parity between their COVID testing methods. Testing results were similar, indicating very few asymptomatic dental patients tested positive. Staff treating patients later determined positive for COVID were not infected. Conclusions: In an area of low, moderate, and high transmission, providers can feel confident that stringent adherence to recommended COVID precautions can safeguard staff and patients, including during aerosol-generating dental procedures. While testing is an important public health tool and helpful in reassuring staff and patients, one center determined it was no longer necessary to the safe and effective delivery of dental services. By the completion of the project, the other center was evaluating halting pre-procedure testing, and has since stopped testing.

scholarly journals An Evaluation of Knowledge, Awareness, Attitudes, and Behaviors Regarding COVID-19 Among Parents of Pediatric Dental Patients

2021 ◽  
pp. 000992282110598
Author(s):  
Derya Ceyhan ◽  
Zuhal Kirzioglu ◽  
Feyza Yildirim
Keyword(s):  
Close Contact ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Dental Patients ◽  
Attitudes And Behaviors ◽  
Dental Clinics ◽  
Asymptomatic Patients ◽  
And Behaviors ◽  
Asymptomatic Individuals

Children infected with COVID-19 have a critical part in community-based viral transmission. This study aimed to evaluate knowledge, awareness, attitudes, and behaviors of parents of pediatric dental patients on COVID-19 and to present required actions to prevent its spreading. A total of 524 parents took part in this cross-sectional study. A self-administered questionnaire was prepared for determining sociodemographic characteristics and socioeconomic status of parents, along with their COVID-19-related knowledge, awareness, attitudes, and behaviors. In total, 90.6% of parents were unaware that disease may show no symptoms; 61.1% and 32.6% did not know roles of “close contact with asymptomatic patients” and “dentistry practices” in transmission, respectively; 30.2% thought it could be transmitted to their children at dental clinics, and only 16.4% stated their children as carriers. Parents need to be informed on COVID-19 transmission through contact with asymptomatic individuals, risks associated with dentistry practices, and role of children in transmission.

Restorative dental treatment in times of COVID-19

2020 ◽  
Vol 68 ◽  
Author(s):  
Robson de Lima GOMES ◽  
Marlus da Silva PEDROSA ◽  
Claudio Heliomar Vicente da SILVA
Keyword(s):  
Severe Acute Respiratory Syndrome ◽  
Dental Treatment ◽  
Close Contact ◽  
Cross Contamination ◽  
Clinical Protocols ◽  
Know How ◽  
Dental Procedures ◽  
Dental Staff ◽  
Dental Professional ◽  
Restrictive Measures

ABSTRACT Since the outbreak of the Coronavirus Disease 2019 (COVID-19), caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), numerous restrictive measures have been adopted by governments of different countries. The return to elective dental care in Brazil is a reality even during the COVID-19 pandemic. During restorative dental procedures, the dental professional requires close contact with the patient, being exposed to contaminated saliva and fluids. In addition, transmission of COVID-19 by the generation of aerosol produced by dental handipieces may be possible. Thus, the dental staff must know how to act during restorative dental procedures, putting into practice the correct clinical protocols to avoid cross-contamination and COVID-19 spread. The purpose of this article is to review the literature on the biosafety practices especially in the context of restorative dental procedures in times of COVID-19.

Knowledge about emergency and non-emergency dental procedures during covid-19 pandemic

2020 ◽  
Vol 11 (SPL1) ◽  
pp. 1524-1528
Author(s):  
Harshada Ragunathan ◽  
Krithika C ◽  
Tamanna M ◽  
Tanaaz Amjad Khan ◽  
Suresh Kumar G ◽  
...  
Keyword(s):  
Health Care Professionals ◽  
Close Contact ◽  
Healthcare Providers ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Emergency Procedures ◽  
Dental Procedures ◽  
Custom Made ◽  
Novel Coronavirus ◽  
Dental Assistants

The novel Coronavirus (COVID-19) pandemic has become a real challenge for healthcare providers around the world. Recently, it has been recorded that among all the health care professionals dentists, dental assistants, and dental hygienists are at high risk as they are in close contact with patients and are exposed to body fluids of patients. To assess the knowledge and create awareness of changes in the practice of emergency and non – emergency dental procedures during COVID-19 among dental interns. A cross-sectional study was conducted among 100dental interns. As the study was conducted during the pandemic time, a web-based survey was created using google form which composed of a set of 12 structured custom- made questions. The answers were collected and subjected to statistics.It was seen that more than 80% of the dental interns were aware of the guidelines issued by various dental associations regarding changes in dental procedures during COVID-19 pandemic situation. Most of the students were also aware of the term ‘Tele dentistry’ and telecommunications for dental care, consultation and education. Adaptations and adjustments in the dental procedures need to be done to avoid the spread of the disease. Hence, it is important and mandatory for dental professionals and students to be aware of the precautions to be taken when performing emergency as well as non-emergency procedures during this pandemic situation.

scholarly journals COVID-19 in Dental Practice: Transmission Risk, Infection Control Challenge, and Clinical Implications

2020 ◽  
Vol 14 (1) ◽  
pp. 348-354
Author(s):  
Salwa A. Aldahlawi ◽  
Ibtesam K. Afifi
Keyword(s):  
Infection Control ◽  
Health Care Providers ◽  
Dental Care ◽  
Close Contact ◽  
Control Measures ◽  
Transmission Risk ◽  
Care Providers ◽  
Modes Of Transmission ◽  
Dental Patients ◽  
Asymptomatic Patients

Objective: The COVID-19 pandemic has become a worldwide, significant public health challenge. Dental care providers are at high risk due to the nature of their profession, which necessitates close proximity to the patient's oropharyngeal region and the use of droplet and aerosol-generating procedures. Methods: A review of the evolving literature on the COVID-19 pandemic was conducted. Published articles addressing SARS-CoV2 transmission modes and risks, and infection control procedures required in the dental office to protect dental patients and health care providers were assessed. Also, clinical guidelines on the management of dental patients during the pandemic were reviewed. Results: The established modes of transmission of SARS-CoV2 appear to be through respiratory droplets and through close contact with either symptomatic or asymptomatic patients. In addition to standard precautions of infection control widely followed in dental practices, extra precautionary measures are needed to control the spread of this highly infectious disease. Dental treatment during the pandemic is limited to emergent and urgent cases after a meticulous patient risk assessment and dental needs are triaged to minimize the risk of COVID-19 transmission and avoid cross-contamination. Conclusion: Dentists should be aware of the recently updated knowledge about COVID-19 modes of transmission and the recommended infection control measures in dental settings. Effective management protocols to regulate droplet and aerosol contamination in the dental clinic should be implemented to deliver dental care in a safe environment.

scholarly journals COVID-19 Outbreak in a Hemodialysis Center Using Universal Masking and Eye Protection

2021 ◽  
Vol 1 (S1) ◽  
pp. s50-s50
Author(s):  
Costi Sifri ◽  
Joan Buckner ◽  
Cady Shelton
Keyword(s):  
Patient Adherence ◽  
Close Contact ◽  
Healthcare Providers ◽  
Healthcare Setting ◽  
Face Mask ◽  
Rt Pcr ◽  
Eye Protection ◽  
Increased Risk ◽  
Source Case ◽  
Asymptomatic Individuals

Background: Up to half of all new SARS-CoV-2 infections are acquired from presymptomatic or asymptomatic individuals. Hemodialysis patients and healthcare providers (HCPs) may be at increased risk for COVID-19 due to the need for extended close contact. Universal masking and eye protection are strategies used to reduce SARS-CoV-2 exposure, particularly from presymptomatic or asymptomatic individuals. We describe an outbreak of COVID-19 in an outpatient hemodialysis center despite universal masking and universal HCP eye protection. Methods: An COVID-19 outbreak investigation was performed in a hemodialysis center where universal masking was in use by all HCPs and patients and universal eye protection (goggles, safety glasses) was in use by all HCPs when directly encountering patients. After a cluster of cases was identified in early November 2020, all patients and HCPs were tested for SARS-CoV-2 by real-time reverse transcription polymerase chain reaction (RT-PCR) when symptomatic and weekly until the conclusion of the outbreak. Results: From November 12, 2020, through December 7, 2020, 14 (23.3%) of 60 patients and 9 (28.1%) of 32 HCPs tested positive for SARS-CoV-2 by RT-PCR (Figure 1). The median ages of the patients and HCPs were 64 years (range, 42–87) and 42 years (range, 29–68), respectively. Also, 5 (5.4%) individuals (3 patients and 2 HCPs) were asymptomatic at the time of testing. Furthermore, 7 (7.6%) individuals (5 patients and 2 HPCs) were hospitalized; 2 patients and no HCPs died. No lapses in universal masking or, for HCPs, eye protection prior to or during the outbreak were identified during the investigation. All HCPs and patients wore medical-grade face masks that were discarded at the end of the day; HCPs wore safety glasses or goggles during patient interactions. Although audits of face mask and eye protection compliance were not performed, independent interviews supported high HCP and patient adherence prior to the outbreak. Neither the staff nor patients shared meals at or outside the hemodialysis center. Most patients and HCPs shared the same hemodialysis shift, suggesting the presence of an index case; however, a source case could not be identified despite an extensive investigation. Conclusions: Universal masking and eye protection have been shown to reduce transmission of SARS-CoV-2 from presymptomatic or asymptomatic individuals in the healthcare setting. This report suggests that such measures cannot prevent all outbreaks. We speculate that certain factors associated with hemodialysis care, such as prolonged close patient–HCP contact, may have facilitated this outbreak. Whether nonadherence to universal masking and eye protection or failure of empiric droplet precautions contributed to this outbreak remains unknown.Funding: NoDisclosures: None

scholarly journals The First Harmonic of Radial Pulse as an Early Predictor of Silent Coronary Artery Disease and Adverse Cardiac Events in Type 2 Diabetic Patients

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Chi-Wei Chang ◽  
Kuo-meng Liao ◽  
Yi-Ting Chang ◽  
Sheng-Hung Wang ◽  
Ying-chun Chen ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Hazard Ratio ◽  
Radial Pulse ◽  
Cardiac Events ◽  
Asymptomatic Patients ◽  
Adverse Cardiac Events ◽  
Silent Coronary Artery Disease ◽  
Artery Disease ◽  
Asymptomatic Individuals

Background. It has been reported that harmonics of radial pulse is related to coronary artery disease (CAD) in patients with type 2 diabetes mellitus (T2DM). It is still unclear whether or not the first harmonics of the radial pulse spectrum is an early independent predictor of silent coronary artery disease (SCAD) and adverse cardiac events (ACE). Objectives. To measure the risk of SCAD in patients with T2DM and also to survey whether or not an increment of the first harmonic (C1) of the radial pulse increases ACE. Methods. 1968 asymptomatic individuals with T2DM underwent radial pulse wave measurement. First harmonic of the radial pressure wave, C1, was calculated. Next, the new occurrence of ACE and the new symptoms and signs of coronary artery disease were recorded. The follow-up period lasted for 14.7 ± 3.5 months. Results. Out of 1968 asymptomatic individuals with T2DM, ACE was detected in 239 (12%) of them during the follow-up period. The logrank test demonstrated that the cumulative incidence of ACE in patients with C1 above 0.96 was greater than that in those patients with C1 below 0.89 (P<0.01). By comparing the data of patients with C1 smaller than the first quartile and the patients with C1 greater than the third quartile, the hazard ratios were listed as follows: ACE (hazard ratio, 2.29; 95% CI, 1.55–3.37), heart failure (hazard ratio, 2.22; 95% CI, 1.21–4.09), myocardial infarction (hazard ratio, 2.44; 95% CI, 1.51–3.93), left ventricular dysfunction (Hazard ratio, 2.01; 95% CI, 0.86–4.70), and new symptoms and signs for coronary artery disease (hazard ratio, 2.03; 95% CI, 1.45–2.84). As C1 increased, the risk for composite ACE (P<0.001 for trend) and for coronary disease (P<0.001 for trend) also increased. The hazard ratio and trend for cardiovascular-cause mortality were not significant. Conclusions. This study showed that C1 of the radial pulse wave is correlated with cardiovascular events. Survival analysis showed that C1 value is an independent predictor of ACE and SCAD in asymptomatic patients with T2DM. Thus, screening for the first harmonic of the radial pulse may improve the risk stratification of cardiac events and SCAD in asymptomatic patients although they had no history of coronary artery disease or angina-related symptom.

scholarly journals Differential Kinetics of Cycle Threshold Values during Admission by Symptoms among Patients with Mild COVID-19: A Prospective Cohort Study

2021 ◽  
Vol 18 (15) ◽  
pp. 8181
Author(s):  
Teppei Sakano ◽  
Mitsuyoshi Urashima ◽  
Hiroyuki Takao ◽  
Kohei Takeshita ◽  
Hiroe Kobashi ◽  
...  
Keyword(s):  
Cohort Study ◽  
Viral Load ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Polymerase Chain Reaction Test ◽  
Cycle Threshold ◽  
Viral Loads ◽  
Asymptomatic Patients ◽  
Asymptomatic Individuals ◽  
Chain Reaction Test

In the coronavirus disease 2019 (COVID-19) pandemic, more than half of the cases of transmission may occur via asymptomatic individuals, which makes it difficult to contain. However, whether viral load in the throat during admission is different between asymptomatic and symptomatic patients is not well known. By conducting a prospective cohort study of patients with asymptomatic or mild COVID-19, cycle threshold (Ct) values of the polymerase chain reaction test for COVID-19 were examined every other day during admission. The Ct values during admission increased more steadily in symptomatic patients and febrile patients than in asymptomatic patients, with significance (p = 0.01 and p = 0.004, respectively), although the Ct values as a whole were not significantly different between the two groups. Moreover, the Ct values as a whole were higher in patients with dysosmia/dysgeusia than in those without it (p = 0.02), whereas they were lower in patients with a headache than those without (p = 0.01). Patients who were IgG-positive at discharge maintained higher Ct values, e.g., more than 35, during admission than those with IgG-negative (p = 0.03). Assuming that viral load and Ct values are negatively associated, the viral loads as a whole and their changes by time may be different by symptoms and immune reaction, i.e., IgG-positive at discharge.

scholarly journals Simulations of the spread of COVID-19 and control policies in Tunisia

2020 ◽  
Author(s):  
Slimane BenMiled ◽  
Amira Kebir
Keyword(s):  
Epidemiological Model ◽  
Tunisian Population ◽  
Control Policies ◽  
Asymptomatic Patients ◽  
Asymptomatic Individuals ◽  
And Control

AbstractWe develop and analyze in this work an epidemiological model for COVID-19 using Tunisian data. Our aims are first to evaluate Tunisian control policies for COVID-19 and secondly to understand the effect of different screening, quarantine and containment strategies and the rule of the asymptomatic patients on the spread of the virus in the Tunisian population. With this work, we show that Tunisian control policies are efficient in screening infected and asymptomatic individuals and that if containment and curfew are maintained the epidemic will be quickly contained.

scholarly journals A Framework for Equity Access to Primary Dental Care

2020 ◽  
Vol 25 (9) ◽  
pp. 3669-3676
Author(s):  
Denise Silveira Antunes ◽  
Sudeshni Naidoo ◽  
Neil Myburgh ◽  
Juliana Balbinot Hilgert ◽  
Paul Douglas Fisher ◽  
...  
Keyword(s):  
Dental Care ◽  
Dental Treatment ◽  
Waiting Times ◽  
Face Validity ◽  
Oral Disease ◽  
Care Practice ◽  
Dental Services ◽  
Dental Staff ◽  
Dental Rehabilitation ◽  
Oral Disease Prevention

Abstract The objective of this study was to demonstrate face validity with a novel resource allocation framework designed to maximize equity into dental booking systems. The study was carried out in 2014. Eleven experts in primary dental care practice in Southern Brazil participated, using a three-round consensus group technique. First, the experts reached consensus on the items to be included in a 5-level diagnostic scale. They identified 21 clinical conditions and categorized them according to the oral health intervention required. Then, they described workload and activity standards for dental staff to carry out health promotion, oral disease prevention, dental treatment, dental rehabilitation, and urgent dental care. Finally, they agreed upon a set of wait times for primary dental care, establishing maximum waits from 2 to 365 days, according to the diagnostic classification. The framework demonstrated potential ability to promote more equitable access to primary dental services, since equal diagnostic classifications share the same waiting times for the dental care they require.

scholarly journals Perception and Experiences of the Front Line Health Workers (FLWs) Attending Suspected or Confirmed Covid-19 Patients in Bangladesh: a Cross-sectional Study

2021 ◽  
Author(s):  
Bushra Zarin Islam ◽  
Mir Raihanul Islam ◽  
Samiun Nazrin Bente Kamal Tune ◽  
Syed Masud Ahmed
Keyword(s):  
Mental Health Problems ◽  
Health Workers ◽  
Close Contact ◽  
Descriptive Analysis ◽  
Integrated Approach ◽  
Snowball Sampling ◽  
Front Line ◽  
Cross Sectional ◽  
Asymptomatic Patients

Abstract Background: Front-line health workers (FLWs) are always at a very high risk of being infected by COVID 19 due to their close contact with patients; thus, proper protection is critical. Concerning the FLWs' safety, Bangladesh's haphazard health system preparedness response on the eve of the pandemic triggered an uncoordinated management crisis, making the FLWs even more vulnerable. This study aims to elicit FLWs' perceptions and experiences regarding personal safety against COVID-19 while attending suspected/confirmed cases in the pandemic's early days. Methods: A mixed-methods quick telephone survey of a cross-sectional design was conducted during April and May 2020. 60 FLWs of various categories and levels from 14 districts and 43 institutions participated in the study in two rounds (initial and follow up) by four weeks apart. The participants were chosen using a combination of purposive sampling and the snowball sampling method and responded to a semi-structured questionnaire. Descriptive analysis was done for quantitative data, and qualitative data were thematically analysed.Results: The FLWs were obvious about the necessity of using Personal Protective Equipment (PPEs) for suspected/confirmed COVID-19 cases with suspected/asymptomatic patients. All types and levels of FLWs did not get the needed formal training on COVID-19 management and prevention. During the initial round, only 75% and 57% FLWs received PPEs and training for their proper use, respectively. Concerns about spreading the infection to family members precipitated mental health problems for the FLWs, so they recommended some safety measures, e.g. separate accommodation, transport, modified duty roaster during COVID placement. After almost a month, the follow-up round showed that a total of 76% FLWs received PPEs, but only 20% received training about them during the last month. The recommended measures were found to be more beneficial for physicians than the other FLWs. Conclusion: COVID 19 highlighted the shortcomings of Bangladesh's health systems and the low priority given to public health. This hampered the COVID 19 response, which was late, fragmented, and poorly coordinated, putting the FLWs at risk even more. Nonetheless, a coordinated, integrated approach involving all relevant authorities is required, and the health ministry should direct an efficient and inclusive COVID response.

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