Dentist blog from Delta Dental

Tag: infection control (Page 1 of 2)

Spore test your sterilizers for quality assessment

Monitoring sterilizer functionality is crucial for every office. If your California-based practice has a quality assessment (QA) review coming up, you’ll want to be absolutely certain that you’re properly spore testing all sterilizers on a weekly basis. Improperly sterilized equipment is one of the most common reasons for QA non-compliance.

Spore testing, or biological monitoring, remains the best assurance that sterilization equipment is functioning and that your office is performing instrument processing procedures correctly. Spore testing assesses the killing of highly resistant Geobacillus and Bacillus spores. Inactivation of these microorganisms strongly implies that other potential pathogens in the load have been eliminated.

Here’s a checklist of important points to keep in mind to make sure your practice is safe and compliant when it comes to spore testing sterilizers.

Spore test all sterilizers

You must test all sterilizers present in your sterilization area. If a sterilizer is not currently being used, or is considered a back-up, it still must be spore tested at least weekly. To remain in compliance, store out of use or broken sterilizers away from the sterilization space in your practice if you are not conducting weekly spore testing on them.

Spore test at least once a week

California Code of Regulations states: “Proper functioning of the sterilization cycle of all sterilization devices shall be verified at least weekly through the use of a biological indicator (such as a spore test). Test results shall be documented and maintained for 12 months.”

In addition, the Centers for Disease Control and Prevention and the American Dental Association both recommend sterilizers be monitored at least weekly with biological indicators.

Retain records of spore testing for at least a year

With mail-in services, recordkeeping is done by the monitoring service. During a QA review, the examiner reviews records related to spore testing, so be sure to have them on hand for at least the past 12 months.

Remove any sterilizer with a positive test

If a positive test is reported on a sterilizer, immediately retest the sterilizer using the same cycle that produced the positive result. The sterilizer must be removed from service until you get a passing result from the retest.  Most failed spore tests are due to operator error, so a passed retest confirms that the sterilizer is safe to use.  Remember to document both the failed test and the passing retest in this scenario.

If the retest confirms a positive spore growth, then the sterilizer must remain out of service and all instruments that were sterilized by that machine must be recalled from use and re-sterilized through a different sterilizer to confirm that they are safe for patient care. The broken sterilizer must be inspected, repaired and re-challenged by passing three consecutive spore tests taken on three fully loaded cycles prior to returning the sterilizer to service.

During a QA review, it is not uncommon for an auditor to see failed spore testing results. A failed spore test will not cause a failure of the QA review so long as the office followed and documented the proper protocols after a failed spore test to ensure safe care for patients.

Do not substitute other forms of testing for spore tests

Spore testing is the standard for assuring proper sterilization of dental instruments. Mechanical or chemical indicators can help with the detection of procedural errors or malfunctions, but they do not verify sterility, and they do not replace the need for weekly spore test.

How to tackle antibiotic overprescription

In 2019, American health care providers of all specialties wrote a total of 251.1 million antibiotic prescriptions — that’s enough for three-quarters of Americans to receive at least one. That number wouldn’t necessarily a problem if all of the prescriptions were necessary and prescribed within guidelines set by health care associations, but that isn’t always the case. In fact, nearly a quarter of prescriptions are most likely unnecessary, according to a cross-sectional study.

And, unfortunately, dentists are some of the top antibiotic prescribers in the United States.

Why antibiotic stewardship is important

Being thoughtful when prescribing antibiotics is part of a practice called antibiotic stewardship. Antibiotic stewardship is an effort to improve how antibiotics are prescribed and used. The goal is ultimately to treat infections more efficiently and to combat antibiotic resistance.

The most dangerous result of antibiotic overprescription is antibiotic resistance. When germs are exposed to antibiotics but not killed, they evolve and develop resistance to drugs. Those resistant germs cause infections that are difficult, if not impossible, to treat and can increase the mortality rates of once treatable infections.

When antibiotics are prescribed improperly, patients may have to deal with the adverse physical effects of antibiotic treatment for no reason. Common adverse effects include nausea, abdominal pain and vomiting, and they happen in almost 10% of patients. Even more, antibiotics can be a financial burden. Without insurance coverage, the average cost of generic antibiotics is about $43 for a 500mg dosage.

The dentist’s role in overprescription

According to surveys of antibiotic prescriptions in the U.S., dentists write one in 10 antibiotic prescriptions.  In a study done on prescription rates in Australia, England, the U.S. and British Columbia, dentists in the U.S. were found to be the most prolific antibiotic prescribers. American dentists prescribed twice the amount of antibiotics that Australia, the least prolific, did per 1000 population. Studies reveal that almost 81% of antibiotics prescribed by dentists are used against stewardship guidelines.

Antibiotics are a vital tool in dental health, especially when treating patients with comorbidities that can increase the danger of an infection, like heart disease. The American Heart Association recommends that only patients at the highest risk for adverse outcomes from infections should be prescribed antibiotics. They should absolutely be prescribed when necessary. But before you prescribe, take a moment to consider whether antibiotics are necessary.

There isn’t a “one size fits all” approach to managing antibiotic use. The reason antibiotic overprescription is so prevalent is also the reason it’s difficult to change: medical decision-making is incredibly complex. To tackle overprescription in your own practice, you can:

Use the tips above to be antibiotic aware and to inform your colleagues and patients about the importance of antibiotics stewardship.

Common questions your patients may have about the COVID-19 vaccine

As the COVID-19 vaccine is becoming more accessible throughout the country, you may find more of your patients talking about it and asking questions. Unfortunately, there’s a lot of conflicting and inaccurate information being spread through various media channels. Staying on top of the truth can be a full-time job, but here’s a list of common questions and some points you can bring up in case your patients come to you with concerns about the vaccine.

Is the vaccine safe?

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  • Concerns about catching COVID-19 from a vaccine shot. There is no live virus used in the vaccines, so people who receive them can’t contract COVID-19.
  • Concerns about the vaccine damaging cells’ DNA. mRNA vaccines don’t alter cell DNA. Instead, they teach cells how to make a protein, which generates an immune response that will help cells target similar proteins in the COVID-19 coronavirus.
  • Concerns about the vaccines being developed recklessly or too quickly. The vaccines have been tested on tens of thousands of patients. Pfizer and Moderna have published ingredient lists for their vaccines, and the mRNA technology used to make the vaccines has been in development for over 30 years.

I’ve heard reports of people having aches, chills and other symptoms after getting vaccinated. Is this an issue?

No. Some people who have gotten the vaccine have reported muscle pain, chills and headaches, but that is not unusual for vaccines. These are part of the body’s normal immune response. But if you’ve had an allergic reaction to vaccines in the past (which is due to the ingredients used in the vaccines), then you should first consult with your health care provider.

Should I still get a vaccine if I’ve had COVID-19 previously?

Yes. It’s not clear if having contracted COVID-19 previously grants long-term resistance and immunity, like chicken pox does. Even for those who have been infected previously, the CDC still recommends getting vaccinated.

COVID-19 doesn’t seem that deadly. Should I get a vaccine if I’m not in a high-risk category?

Yes. It’s true that as a percentage, most people who contract COVID-19 don’t die from it. Still, there can be serious long-term consequences such as lung, heart or brain damage. And even someone who doesn’t get seriously ill can still spread the disease among others who are more vulnerable. Getting a vaccine helps you protect not just your family and loved ones, but also society as a whole. These are important reasons to get the vaccine.

Once I’ve been vaccinated, do I still need to wear a mask or socially distance?

Yes. Even if a person has been vaccinated, that doesn’t mean that he or she can’t still spread the virus. It takes at least 10 days for the body to develop antibodies, and the number of antibodies present only goes up with more time. Additionally, research hasn’t conclusively determined if the vaccines prevent asymptomatic infection and spread (although it is likely that they do). Wearing a mask and socially distancing are also good behaviors to model for those who haven’t been vaccinated yet. By getting vaccinated and following other preventive measures, you can do your part to end the pandemic sooner!

I’ve heard that the vaccine contains a chip inside that lets the government and corporations track people who get vaccinated. Is this true?

No. Some syringe makers include a microchip within the label of their syringes so that health care providers can track the shipping history and origin of doses of vaccine, but there is no chip in the vaccine itself.

I heard that the vaccine targets a protein that occurs naturally in pregnant women and can cause fertility issues. Is this true?

No. An amino acid sequence is shared between COVID-19 and a placental protein found in pregnant women, but the sequence is too short to trigger an immune response by itself. COVID-19 vaccines won’t cause fertility issues in women.

For further information on key facts about the vaccine and how you can play a role as a trusted health care provider, please consult the American Dental Association’s COVID-19 vaccine page.

Dentists and the COVID-19 vaccine: what to know

After a somewhat rocky start, the COVID-19 vaccine rollout seems to be progressing favorably for dental professionals. Most states now consider dentists to be essential health care workers eligible for priority vaccination, and many states now allow dentists to administer the vaccine to their patients. 

Most dentists can get the vaccine

Most states now include dentists as essential health care workers eligible for their first phase of vaccination, according to the most recent information complied by the American Dental Association (ADA).

  • Currently, more than half of states place dentists in the highest priority tier, 1a, for immunization.
  • Several states, including Florida, Minnesota, and Nevada, also include dentists in their first phase of immunizations, but give counties the discretion to prioritize them higher or lower within that phase.
  • Other states, including Colorado, Louisiana and North and South Dakota, include dentists in their first phase of immunizations but place them in a lower-priority tier than other essential health care workers.

Only a few states don’t consider dentists to be essential workers. Oklahoma classifies dentists as part of a group of “allied health fields and general outpatient health service priority groups” that will be eligible for the vaccine as part of the state’s second phase of immunizations. Texas, meanwhile, has not yet determined where dentists will fall within its immunization plan.

Some dental staff can also get the vaccine — and may be required to do so

Several states, including Arkansas, Georgia, Iowa, New York and Wisconsin, consider dental office staff such as dental hygienists to be essential health care workers eligible for priority vaccination.

Dental practice owners may also be able to require their staff to receive the vaccine. There are some important caveats to consider, though. For instance, if your practice has 15 or more employees, a vaccination requirement must accommodate disabilities, including pregnancy-related issues, under the Americans with Disabilities Act, and must respect staff members’ religious beliefs. You may also be required to pay for the vaccinations.

Despite these challenges, it might be an option worth pursuing. A recent survey found that 64% of patients who were hesitant to return to their dental office would be willing to do so if the entire staff had received the COVID-19 vaccine.

Many dentists can administer the vaccine

Currently, dentists in at least 20 states can administer the COVID-19 vaccine. It’s worth noting, however, that not all these states will necessarily allow dentists to vaccinate patients in their dental offices.

For instance, the California Dental Association says it’s unlikely that dentists in the state will be able to administer vaccines from their dental offices because of storage requirements, billing issues and space requirements for patients who need to be monitored after they receive the vaccine. More likely, they say, is that dentists will be able administer the vaccine at hospitals or through government vaccination programs, such as mass vaccination sites.

In New York, dentists can administer the vaccine only at sites overseen or approved by the state or a local health department and supervised by physicians, physician assistants or nurse practitioners.

Members of your staff may also be able administer the vaccine. For instance, California and some other states will allow dental hygienists to do so.

To help you determine your state’s rules about administering the vaccine, the ADA has created an interactive map with the latest updates.

In eligible states, dentists and dental hygienists who wish to administer the vaccine may also have to complete training beforehand. The ADA has compiled a state-by-state guide that includes information about the vaccine, educational resources and training.

Finally, the ADA is also requesting that the federal government grant liability protection to dentists who administer the COVID-19 vaccine.

Return to Care supplemental reimbursement program extended through 2020

To help you continue to provide care to your Delta Dental patients during the ongoing COVID-19 pandemic, we’re extending the Return to Care supplemental reimbursement program through December 31, 2020.

As a network dentist, you’ll receive a $10 supplemental reimbursement for performing qualifying evaluation or consultation codes. The program launched June 22 and was later extended to October 20.

The latest extension to December 31 is meant to offer you additional support and help you adjust to the new conditions as you prepare for 2021. There are no other changes to the program that is currently in place.

For more details on the supplemental reimbursement program, please see the complete FAQ.

As before, to receive the reimbursement, you must participate in one of the following networks and treat an eligible patient covered by one of these Delta Dental plans:

  • DeltaCare® USA
  • Delta Dental PPO™ and DPO in Texas (see applicable Delta Dental companies below)
  • Delta Dental Premier® (see applicable Delta Dental companies below)
  • Delta Dental Federal (Legion), Medicare Advantage

Applicable Delta Dental companies include Delta Dental of California, Delta Dental Insurance Company, Delta Dental of Pennsylvania, Delta Dental of the District of Columbia, Delta Dental of Delaware, Inc., Delta Dental of West Virginia, Inc. and Delta Dental of New York, Inc.

The Medi-Cal Dental, CDPHP (NY Medicaid) and HSCSN (Washington, D.C. Medicaid) networks are not eligible for this reimbursement.

Reopening: A success story from Modesto, California

The coronavirus pandemic has been difficult for everyone, but it has been particularly tough on the dental industry. In mid-April of this year, for instance, almost 95% of dental practices reported being either closed completely or open only for emergency patients, according to an American Dental Association (ADA) survey. Most practices reported that their practice volumes were less than 5% of usual, and collections were also down dramatically.

While the pandemic continues, many practices have been able to reopen successfully. And their patients are returning. But reopening hasn’t been without its struggles. 

Dr. Ray R. Rodig, DDS, owner of the Vintage Dental practice in Modesto, California, talks about the process of reopening, some of the challenges — both expected and unexpected — and offers some tips and best practices for others in the same situation.

For how long was your practice closed?

Almost 11 weeks.

When did you reopen?

May 26, 2020.

Why did you decide upon that date?

We had done all of our research into what would keep our patients and team members healthy and safe at the office. We had a couple of “practice runs” the week before to work out our new patient flow to make sure it was workable, safe, complete and comfortable for patients and team alike. While hard to get, we had all the PPE we needed, our air purifiers and sneeze guards were in place — we were ready to go back to work, and the ADA said it was safe.

What challenges did you face initially?

The fear and uncertainty of both patients and team members — some patients are still not comfortable returning and have appointed out into November and December. There’s also a balancing act with moving our patients through the office, making sure there’s no “traffic jams” — no one coming in contact with each other in the office. And finding and ordering PPE was very difficult. Thank goodness for our local Stanislaus Dental Society! They really helped and kept us in the loop.

Which was the most difficult to address?

Some people — very few — are just put off by having to wear masks. We explain that they’ll only need them entering and leaving the office and that we’ll even provide them, but some folks just don’t want to accept this. We’re patient and understand completely, but we just need to keep everyone safe. No exceptions.

Did you encounter any challenges that you weren’t expecting or that surprised you?

The heat and stress of wearing the extra PPE really surprised us. Just breathing takes so much more energy — learning to breathe with N95s, wearing both scrubs and full-length gowns together. It creates a lot of heat and stress that we didn’t even think about before we started back.

Which challenges have been resolved and which are ongoing?

The biggest challenge we seem to have is letting our operatories sit empty for five minutes. We need a bit more time to turn over the operatories now, which creates a scheduling issue. We’ve resolved this by revamping the schedule, but it continues to evolve daily, as no day is ever the same, and turning over the operatories and taking the extra time to complete a thorough sterilization is a challenge.

I’d also say closing our reception area has been a real process. It’s yet another scheduling issue involving the flow through the office, but our patients understand what we’re doing and why, so it’s really become a non-issue.

And we’re getting used to the hot PPE, but I’m sure hoping this doesn’t become the “new normal.” It’s sure hard to visit with our patients now.

How did your staff react to returning to work? Did any refuse?

Thankfully, our team was ready to come back to work — not one person refused. Some voiced safety concerns in our team Zoom calls prior to reopening, but we answered their concerns, and everyone came back.

What additional precautions have you had to take in your office?

We closed our reception area, and our patients must call and wait in their cars for their appointments — this was very odd for us since we like to visit with our patients, but they seem to understand. We also don’t allow extra persons to come with them unless they have appointments, too. All patients need to answer a series of questions, sanitize their hands and have their temperature taken before we’ll take them to their operatory. Temperatures of all team members are taken as they enter and as they leave each day.

Our team members in the back office wear two masks (one being an N95), a face shield, scrubs and a full-length surgical gown, and most like to wear bouffant caps. Before COVID, we only wore level 3 masks, face shields and lab coats.

We have limited the use of the cavitron, and have external vacuum machines to help suction any aerosols away while in treatment or hygiene; we use Isolites as well.

Our front team wears masks and are stationed behind large sneeze guards, and they’re constantly sanitizing all pens, files, countertops, etc. There’s hand sanitizer everywhere. The office is fogged daily, and we have air purifiers in every operatory.

Additionally, we started using a COVID-19 testing program weeks ago through Pathnostic. We have kits on hand, and if someone isn’t feeling well, has a cough or fever, or has come in contact with someone they think (or know) has been ill or had COVID-19, we have kits in the office that are simple to use, comfortable, and we get results back in a couple of days.

I highly recommend these for safety and peace of mind, and they’re not scary, painful tests. There’s no cost to the office or the person being tested. We’ve tested team members, family members, friends, patients — and everyone is surprised at how easy they are to do, and how fast we get the results back. It’s comforting to know we can find out quickly if there’s a problem.

Have you had to discontinue use of certain equipment or purchase new equipment?

We have limited the use of cavitrons — the hygienists have external suction machines to limit aerosols in addition to air purifiers in their operatories, so we leave it up to the hygienists to decide whether to use it. As far as equipment is concerned, we have really only purchased air purifiers for each operatory and a fogger we use daily at this point. Our office has always been very sterile and safe, so we didn’t have to change or add much.

What kinds of additional expenses have you faced as a result?

The professional installation of sneeze guards was a bit pricey but certainly necessary, and the cost of PPE went through the roof — that’s quite an expense right there.

How do ask your patients to prepare for a visit?

Our front office will call our patients the day prior to their appointment and ask all the same questions that we will ask when they arrive for their appointment. We don’t want them to show up and not be able to see them due to travel, or fever, or coming in contact with someone who may be sick. We ask that they wear a mask, arrive at the time of their appointment, call us from their car when they arrive, and we call them back to let them know when to come inside.

What do ask your patients to do when they arrive?

Our reception area is locked; when they call to let us know they’ve arrived, we let them know that we will call them back when they can enter. Once their assistant or hygienist is ready, we call and ask them to come on in. Our team opens the door, so patients don’t have to touch the door handle.

How have your patients responded?

Some have been a bit confused at first, but 99.99% of our patients are happy we’re working hard to keep them safe and healthy. The .01% that are unhappy about wearing masks are still appreciative of our efforts. Some are pretty amazed at all the precautions we take and have taken some of our ideas to implement in their homes.

Have your patients had any concerns? How have you addressed them?

Their concerns seem to center around safety. Once we walk them through the process over the phone, they understand that each patient is carefully screened and put through the same process they’re going through, as well as our team members. Most are confident by the time they get here and are definitely confident when they leave.

What is your current situation in terms of patient volume? Collections?

We were very surprised at how busy we were right from time we reopened and we’ve continued to stay busy — new patients, patients coming back for treatment diagnosed prior to closure, past patients with new treatment needs — people seem to be excited to be able to get back to keeping their teeth healthy. Our collections have exceeded our expectations, as has the patient attendance. We were pleasantly surprised.

How has this changed since you initially opened?

Our patient flow is much more of a rhythm now — at first it was disconcerting implementing all the new steps, but now it’s a habit and much easier. I’m also blessed with a great team and great patients.

What advice do you have for other dentists in a similar situation?

I’d say everything can be really overwhelming at first, but as the old saying goes, “How do you eat an elephant?  One bite at a time.”  Do your research, figure out what works best for you and your team, find out what is working for other professionals in your local dental community and emulate them.

We thought it would be very hard to reopen, and while it seemed very challenging at the beginning, it became easier sooner than we anticipated. And let your patients know what you’re doing to keep them safe — they’ll appreciate that.

Is there anything you’d caution other dentists about or recommend that they look out for?

I’d make sure that your team knows how important it is to everyone that they practice social distancing in the office. 

We protect ourselves from our patients, but once the PPE comes off and we’re with our “office family” we can’t forget that we need to keep our distance from each other. This isn’t the easiest thing to do — we have staggered lunches, plenty of room in our breakroom and wear masks when not eating. 

And remind your team about social distancing and wearing masks away from the office. We need to protect each other.

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