When COVID first emerged, it was very clear that all professions including dental, medical and allied health were scrambling to deal with balancing community transmission risk with maintaining some level of access to care. Some professions shut down altogether and many people would recall that elective surgeries were shut for occupations such as ENTs for months.
At the time, it was clear that dentistry could either come up with its own triage system for the profession based on some existing frameworks for urgency of care, or would likely risk being shut down altogether and potentially grouped with elective surgeries or even retail.
So the levels of restrictions were developed and approved by the AHPPC (Australian Health Protection Principal Committee) as a means of allowing the profession to navigate its way to increasingly higher levels of restrictions in lock step with other community and healthcare restrictions, but also conversely, to step out of restrictions as community risks diminished.
As the situation has evolved in different states, we have seen different levels of restrictions based on the situation in that region. The levels document served the profession well in the acute phase of the pandemic as it provided some clarity in those very early months about how dentists could play their part in reducing risks to themselves, their staff and reducing community movement when there were so many unknown factors about the virus and how we could effectively reduce risks.
As we have seen from other countries that didn’t have any restrictions, many more dental practitioners and team members have become sick and some have died. While we have access to data from Victoria that shows us some dental practitioners and dental team members contracted COVID, to the knowledge of the committee, we have avoided any dental team members dying in Australia through occupational exposure to COVID-19.
Throughout 2019 and 2020, more than 50 documents and fact sheets were produced by the ADA to help clinicians navigate through the various challenges arising at each stage whether it be around re-starting a clinic after hibernation or cleaning advice or HR considerations.
What has become abundantly clear now is that we are having to live with COVID longterm. Uniform restrictions on dental services longterm is just not sustainable, and people need to access dental care. But what has also evolved is an expectation from the regulator, the Dental Board of Australia, for practitioners to make “risk-based decisions”. Practitioners who have been through quality accreditation will be quite familiar with risk assessments and mitigation frameworks, but a lot of clinicians may be possibly scratching their heads and wondering what does this mean.
Throw into the mix multiple Federal government and State-based organisations publishing their own guidance, and it makes for a very complex landscape for practitioners to navigate.
When the DBA advised that it wanted clinicians to take a risk-based approach to COVID-19 risk mitigation, it became clear that we needed to give some guidance on how clinicians can start to think about and apply risk-based controls using a widely adopted framework, but with dentally relevant examples.
Currently, there are several key documents that have been drawn upon and summarised for the dental profession. These are:
1. The ICEG Document on minimising the risk of infectious respiratory disease transmission in the context of COVID-19: the Hierarchy of controls. This was last updated in July this year and forms a large part of the overall approach. (ICEG is the Infection Control Expert Group that informs the AHPPC.)
This document is about seven pages.
2. The CDNA COVID-19 Guidelines. This document was last updated in October this year and contains all of the most up-to-date information on case definitions, case and contact management, and testing. (The CDNA is the Communicable Diseases Network of Australia.) This document is about 77 pages.
3. Recommendations from the National COVID-19 Clinical Evidence Taskforce in Infection Prevention and Control for Revised Guidance on the use of personal protective equipment for healthcare workers in the context of COVID-19. This document is about eight pages.
And overarching all of this is also the NHNMRC Australian Guidelines for Infection Prevention and Control. This document is about 350 pages.
If we were asking practitioners to read, interpret and keep up to date with all of these documents independently, we’re talking about hundreds of pages of reading and checking to see when updates are made. Not only is it the bulk of material that is a challenge, but some things are not very dental specific, so we then need to go and interpret this for our own dental settings.
Our default position as an Infection Control Committee is that dentists want to do the right thing. They want to protect their team, their patients and the community, and they want to be informed about how to do this. But most of the committee also appreciate the demands on clinicians in terms of the time available to read and interpret all of this complex documentation. In response, the committee was motivated to create a succinct document that reflected the current health landscape and evidence emerging, but in a way that was accessible for the whole dental team.
The role of the Infection Control Committee of the ADA is not so much to set the standards in Australia, but rather to interpret broader Australian health standards, synthesise the myriad regulatory documents that our profession is expected to abide by, and put this into a digestable form that is relevant for dental practices. This is why the DBA has for a long time deferred to the ADA Infection Control Committee to help provide Guidelines for the Profession, because they have recognised the importance of clear, succinct advice that is relevant to a dental practice rather than expecting dentists and their teams to go and read reams of other information and try to apply medical and hospital standards to their day-to-day safe dental operations.
So this is where the Risk management principles for dentistry during the COVID-19 pandemic emerged from. Some clear, step-wise action-based advice on what you can actively do in dental practice to reduce COVID transmission risks. It has more than 80 scientific papers included in the references section that have informed the approach for anyone who wants to take a deep dive into these, but it also contains workable summaries that the dental team can pick up and easily put into action.
If you have any questions, please reach out to members of the Committee through Peer or by emailing [email protected]
