The Compliance Divas Podcast
Our podcast covers current topics such as infection prevention and control, OSHA and HIPAA compliance for dentistry. We discuss the latest regulatory information, answer frequently asked questions and give suggestions for dental practices to make compliance easy and sustainable. The Compliance Divas are a trusted source for consistent, accurate information based upon current guidelines, standards, science, and recommendations.
The Compliance Divas Podcast
#73 CDC September 23, 2022 Updates
Use Left/Right to seek, Home/End to jump to start or end. Hold shift to jump forward or backward.
Do you know about NEW UPDATED CDC COVID-19 Guidelines published on 9-23-22? The COVID-19 pandemic has been a roller coaster of changing guidelines, recommendations, and standards. The Compliance Divas have worked hard to stay abreast of the changes that affect dentistry. Thanks to our perseverance, expertise and connections, you’ll be able to stay right on top of Infection Control updates for dentistry. In this Podcast we help you UNDERSTAND what this update means for you.
Resources:
- CDC Interim Guidance for Managing Healthcare Personnel with SARS-CoV-2 Infection or Exposure to SARS-CoV-2 https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html
- CDC Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html
Welcome. I'm Leslie Cannon. I'm Mary Gavoni.
SPEAKER_03I'm Linda Harvey. I'm Olivia Wan. And together we are the Compliance Divas.
SPEAKER_00Welcome to the Compliance Divas Podcast. We bring clarity and simplicity to compliance by navigating regulatory compliance to keep you on course. You can subscribe to the Compliance Divas Podcast for your favorite podcast channel or on our website, thecompliancedeivas.com. This way you'll never miss an exciting episode. You'll be alerted when episodes become published. Resources that we mentioned during our podcast can be found on the compliance divas website, and we always welcome questions. Please submit your questions to the ComplianceDivas support at the compliancedevas.com. My name is Leslie Cannum. I'm your moderator for this special podcast. Do you know about the new updated CDC COVID-19 guidelines that were published September 23rd of 2022? If you don't, this is a great podcast for you and your team to listen to because we're going to focus on those updates for healthcare personnel. And there's several parts of the update that apply to dental workers, including isolation and quarantine, return to work criteria, and other best practices for COVID-19. You know, the compliance divas have worked very hard to stay abreast of the changes. There's been a roller coaster of changes to guidelines, recommendations, and standards. Thanks to our perseverance, expertise, and connections, you'll be able to stay right on top of infection control updates for dentistry. Again, in this podcast, we're going to focus on the September 23, 2022 update to the CDC guidelines, which may change again, as we're well aware, those CDC guidelines have changed multiple times. It's important for healthcare workers, particularly in dentistry, to stay abreast of the most current guidelines and to print them out and review them with your team. Now, Linda, why don't you give us a little bit of a help on why it's important for healthcare workers to update themselves to be current with these CDC guidelines?
SPEAKER_01Absolutely, Leslie. And as we know, with the continuing cases of COVID and staying abreast of the latest guidelines is extremely important. And I think many offices are beginning to feel they're not interested in keeping up with it or they feel like they can follow the community guidelines and drop the masks, drop all the protocols. And that is not the case. It's very important for them to keep up with the most up-to-date CDC COVID guidelines for several regulatory reasons. First, the CDC guidelines are written into many state dental practice acts, so it's a law. And in other cases, Leslie, as you know, in California, there are special COVID laws in some states. So there's another reason. Third, OSHA has placed dentistry in the highest risk category is because of our aerosol generating procedures. And along with that, dentists have an obligation under the OSHA laws to prove to provide a workplace that is safe from known hazards that are likely to cause death or illness. So COVID falls into all those categories. So keeping up with the latest changes, it means that they are bringing their patients the best safest care possible. So let's revisit a couple things that have happened in the past year, Leslie. So what we saw from September 2021 to here, September 2022, is some big changes for us in dentistry. Last year, September of 2021, the CDC archived our dental interfection control guidelines for COVID, meaning that when they updated them in February, they wrapped dentistry into all of healthcare. So it's important that our listeners understand that dentistry no longer has separate COVID guidelines, we are part of healthcare, as we all know. And to be sure that they've downloaded the most recent copy from September 2022 for their practice to discuss MT meetings and share this podcast as you recommended, Leslie. So even though we will have these resources on our webpage, I will just briefly tell everyone that if you go to cdc.gov and in the search window, type in coronavirus, you'll be taken to a page where you can check on check the box for the updated guidelines for the professional healthcare workers, and you can dive into locating the page from that direction. But you can also download it from our website, Leslie, and we'll have the updates. So listeners, stay tuned. We've got more information coming with another. So go ahead, Leslie.
SPEAKER_00Linda, thank you so much for that information. And I I know that it seems like it's simple enough to just go to the CDC website, but I find that we are so busy in our dental uh settings these days and catching up with dental patients that haven't been seen during COVID and just keeping abreast of all the other infection control changes, that it's important to print out this important information and keep it handy and review it with your staff. So now we know how to get it. Our listeners know how to get it. And if it's too confusing to go to the CDC website to find it, you'll be able to find it right on our website with our resources page. Mary, I know there has been a lot of confusion over source control and masking requirements. Could you please give us what CDC is telling us today regarding source control and uh universal use of PPE?
SPEAKER_02Absolutely. Um, I will go over the today um information, but first I want to kind of back up a little bit and explain why we've had so much confusion. Because there have been two sets of guidelines from the CDC on precautions to take to prevent the spread of COVID. One is for the public and one is for healthcare settings. And so the guidelines for the public have been loosened, if you will, um, not requiring masks in public settings and so forth as the number of cases of COVID declines. And many times people hear that on the news and think it applies to healthcare settings as well. And that isn't always made clear on news reports. And there's a lack of understanding sometimes, even within healthcare facilities, that well, the CDC says we don't have to wear this anymore in a public setting. That doesn't mean a healthcare setting. So source control means that in a healthcare setting, everyone wears a face mask, meaning patients that come in the door, and the team members either wear a face mask while they're in sort of the public areas of the of the dental practice or maybe in the sterilization area, in the break room, and so forth. And then they wear either a mask or a respirator, preferred N95 respirator, when they're doing aerosol generating procedures. But now what's changed in the updated guidance is that if your community transmission levels are low, and Olivia's going to explain what we mean by community transmission levels, if they're low, then the healthcare providers do not need to wear a mask. It's their choice, it's a best practice to wear it, but it's not within the current recommendations when they're outside of the treatment area. And if you're in an area where transmissions levels are low, then your patients don't need to wear a face mask when they come in the office. But that doesn't mean that we don't need to continue to screen patients because we're still required in the guidance to screen for patients who have either been potentially exposed to COVID or they have some respiratory symptoms that may be indicative of COVID. Remember that your respirator that you wear for aerosol generating procedures does need to be changed after every patient. Back in the early days of the pandemic, when they were in short supply, we were allowed to reuse them under an emergency use order or authorization from the Food and Drug Administration. But that's actually expired more than a year ago. And so it must be changed after every patient. And if you're wearing a face mask, that also must be changed after every patient. Now, in terms of universal PPE, remember that we always had to wear PPE to prevent our ourselves or to protect ourselves from bloodborne pathogens. So uh protective clothing and gloves and a face mask and eye protection. And what is recommended from the CDC, still in this COVID pandemic situation, is N95 respirator for aerosol generating procedures and the use of goggles or a face shield so that there isn't any aerosol that's getting up underneath or around safety glasses. So make sure, as Leslie said and Linda said, that you download copies of this guidance and that you really review it carefully so you understand what those requirements are.
SPEAKER_00Mary, thank you so much for that information on source control and universal uh use of PPE, and of course, the reminder to change masks after every patient and respirators after every patient. Olivia, will you help us understand that very confusing part of the CDC's levels? There's community levels and then there's community transmission. What does all of that mean for dental settings?
SPEAKER_03Sure, Leslie. Uh I want to emphasize what Mary discussed, making sure we download and carefully review the CDC updates. And so our listeners may find it helpful to review CDC's document that was updated August 12, 2022 on indicators for monitoring COVID community levels. And that's how they come up with these public health recommendations. So just as a uh refresher, the community levels that CDC uses to measure COVID, there's three different indicators. One is the new COVID hospital admissions per 100,000 population in the last seven days. The second indicator is the percent of staffed inpatient beds occupied by patients with confirmed COVID using a seven-day average. And third indicator is new COVID cases per 100,000 population in the last seven days. So that's important because those community levels actually drive the transmission risk. And in looking at the transmission risk, that will vary state by state, county by county. It will go up, it will go down. So we encourage the practices that we work with to look at the COVID tracker to find out what their uh county risk is based on those community levels. So, for example, I'm looking at right now, uh, I can never find it. So I just Google CDC COVID tracker, and then I put my state and county in, and when I hover over Stewart County, Tennessee, the current community level is low. Well, why do we need to know that information? That's going to drive the selection of appropriate personal protective equipment. So, as Mary stated, in order to select the correct type of respiratory protection, we have to know what our transmission risk is. If it's substantial to high, then that would warrant selecting an N95 respirator or better for aerosol generating procedures. And so we we would not know that week to week unless we're looking at that COVID tracker. Additionally, as Mary pointed out, we did have some updates with source control. So for patients that are visiting the office or for admin persons in areas that are not clinical, those source control options have been revised a bit. So in order to know whether or not you have to wear source control, we once again go to the COVID tracker to see whether that risk is low, medium, or high. And that will govern whether we wear source control or not. But once again, it it is recommended, especially for those that are uh immune compromised or at greater risk. Now, the the importance to recognize with CDC guidance is we are still required to evaluate any local or state public health orders. And so just like with your state, Leslie, there are different orders in place. So that would be confusing if someone is just referencing CDC and overlooking the fact that the State Department of Health has orders in place. So we have to do a juggling act to make sure we're in compliance with state and local authorities. So just to summarize that, Leslie, we want to encourage people to be familiar with their COVID trackers and selecting the correct uh personal protective equipment as it relates to N95s and also to be familiar whether or not source control is recommended. And I think Mary pointed it out beautifully that people are confused with community risk as it relates to being in the general public versus risk as a healthcare provider. Uh, so we want to make sure we're looking at the correct documents.
SPEAKER_00Olivia, that is 100% right on target. And I agree with what Mary said and what you said. Uh our patients are confused. You know, you put your mask on, you take your mask off, put your mask on, take your mask off. They're getting confusing messages everywhere. And if we can somehow drive home the point to our patients, well, we may not have had the mask requirement in our practice last month, but this month, community transmission has changed. And the overriding messaging that we want to give our patients is that we're looking out for you. And so we're going to have to uh switch sometimes to a little bit higher precautions based on the transmission that we're seeing. And while we would all love to get rid of the mask, our focus is on the health of our patients. And that goes all the way from what we do in the treatment room to infection control to what we do in the reception area. So thank you so much for helping clarify that. And I want to spend just a quick minute uh echoing what you said about California. Uh, California does say that you have to wear masks in healthcare settings, including dental. It is a public health order that has not been lifted, and that we must continue to screen patients for aerosol transmissible diseases. That's been a standard in California since 2009. On top of that, now we're also having to screen from monkey pugs. Now, California has always had that on its list of aerosol transmissible diseases, but uh not only CDC, but ADA is encouraging all of its members to screen from monkey pux. Mary, you had something you wanted to add to our I did.
SPEAKER_02Thank you, Leslie. I just want to again, I don't mean to beat the dead horse here, but um, and no offense to our horse lovers, divas, um make sure that that you're looking at, if you're trying to make the decision for your patients whether they need to be wearing source control or the team does, that it's not based on vaccine status any longer, and that it's based on community transmission levels, which may be different than community levels. And that's something that we need to make sure that our patients understand. You can go to the COVID tracker and you look at the map, the county map, and it may say that the community level is low, but for some reason the transmission level may be high or substantial, and that's what drives whether we ask our patients to wear a face mask and whether we wear source control when we're not in the treatment room. I know it's confusing, but it is what it is, and we have to make sure that we understand that.
SPEAKER_00And it certainly bears we're repeating over and over again to help uh bring this message to our listeners to make sure that their practices are as safe as they can be. One other point I wanted to make at is uh one of the continuing changes, what seems to evolve is uh isolation and quarantine and masking if you have had close contact with someone who has tested positive for COVID-19. And they call that a high-risk exposure. We're going to talk a little bit more about that. But what I wanted to point out is when we're screening our patients, one of the questions should be if you've had close contact with someone who has tested positive for COVID-19 in the last 14 days. And if so, that person should be monitoring themselves, but be wearing a tight-fitting or well-fitting mask for at least 10 days. And so that means if they say yes to that question, uh, then we need to make sure that we don't see them during that 10-day period where they're supposed to be wearing a well-fitting mask because they absolutely can't wear a well-fitting mask when we're providing dental treatment. So that's again one of the screening questions. Uh, Mary, can you give us a little bit more information on there? Something that was old, but it's also been brought up again in the uh CDC guidelines specifically for dental settings regarding air conditioning, heating, ventilation. Now that we're going into the winter months where we may find that uh air conditioning is not fun to have on when it's cold outside.
SPEAKER_02Absolutely, Leslie. And this is sort of a transition time for a lot of people in the country where they may be just turning their HVAC systems off. They don't need the air conditioning and they don't need the heating system working yet. And many energy-saving thermostats will have an on-off where it's not running or circulating all the time. And so the recommendation was at the beginning of the pandemic and continues that we set those controls to always running. So there's always a fan that's circulating air, and that's in addition to any air purification systems that you have, because you don't want the fan circulation to stop, and then there be the potential for um additional aerosols to um be dispersed throughout your facility. So you need to make sure that those controls are set to on. So even if you're not air conditioning or heating at the time, that your fan is always on, always circulating air.
SPEAKER_00That's great, great information. And it's uh important again to download these CDC guidelines, print them out so that you can review them and refresh your memory as to what the best practices are. And going back to screening patients, we might add when we confirm our visit with them and ask them the screening questions, we might tell them that our practice might be a little cooler than usual, that we're taking extra precautions with air purifiers and our air conditioning, heating ventilation system, or we may have windows open. So you may want to dress a little bit warmer for your dental appointment. So that's great information. Mary, you also mentioned aerosol generating procedures. So I'd like Linda to remind everyone what is considered an aerosol generating procedure and what are the precautions when we perform an aerosol, aerosol generating procedure.
SPEAKER_01Sure, Leslie. First, I'd like to comment on what you said about dressing warmer in the dental practice. I think that's a very good tip. And I joked here in Florida with some of our clients about reminding patients not to come to their appointments in flip-flops and shorts because it's a little cool. And as we know that many offices provide patient blankets, which end up being contaminated and need to be part of the PPE, so to speak, that health category of laundering that properly is another uh topic. But coming back to aerosols, aerosols defined by the CDC are uh any procedure that creates a suspension of tiny particles of droplets or droplets rather in the air. And we see that with the water, the spray, the spider that comes from the high speed handpiece, the ultrasonic scalar, air water syringe, air polishers, and so forth. So anytime those procedures are being performed in a dental setting, an N95 restorator mask should be in use. As I mentioned. Earlier, Leslie, OSHA has placed industry in the highest risk category because of aerosol generating procedures. So OSHA expects that every employer is going to provide a workplace that's safe for their employees. So one, maintaining worker safety, two, following the guidelines, because in many states they are law, as we've talked about in California and other states. And so wearing that N95 respirator mask is really imperative. As the divisive probably mentioned in other podcasts, the N95 respirator mask filters out the coronavirus size particle, which is 0.3 microns. Whereas a level three mask, even with a face shield, will never filter out a particle size that matches the coronavirus. A level three surgical mask only filters 3.0 size microns. So there's a world of difference, if you will, Leslie, even though it's microscopic, it is a world of difference in being safer and being compliant in wearing those N95 masks.
SPEAKER_00Linda, thank you so much for that. And again, another reminder to our California listeners: N95s are required by CalOSHA for aerosol generating procedures. And while we think that they're that the time to wear them has passed, it has not. OSHA still is very strict about that. So again, California employers, please provide N95 respirators that have been fit tested to employees, change them after every patient, make sure that you've had a respiratory protection plan and that you've conducted the medical evaluation or had that conducted for each employee to make sure that they are physically fit to wear an N95. Olivia, can you remind us what CDC says about open base style seating, like in our orthodontic and pediatric practices?
SPEAKER_03Sure, Leslie. We we do see that in this updated guidance, there is a repeat of that information. So despite the uh risk levels becoming low, we we still have the advice to maintain six feet between the patient chairs. So we should not be going back to the way it was before the pandemic. And I think that will be the everlasting design of dental offices in light of uh respiratory transmission. But uh so six feet between the patient chairs, and also if there's not six feet, then we would need to look at some kind of barriers. I know I have one orthodontic client that actually installed walls, uh felt like it would be a good message for the parents, patients visiting his practice. Um, another thing to look at that's been repeated here is that where feasible, consider patient orientation carefully, placing the patient's head near the return air vents, away from pedestrian corridors, and toward the rear wall when using vestibule type office layouts. So it looks like these types of recommendations are here to stay, and of course, using HEPA air filtration.
SPEAKER_00Thank you, Olivia. I think that really uh sums it up nicely. There's we have things that we have kept from the previous guidelines and things that we could let go of a little bit, but uh other things that are new. And so uh thank you very much for that review. And wrapping up, there's one other very important part of the CDC guidelines that have changed as well, and that is the isolation and quarantine updates. It may be very surprising to many folks to know that uh you could actually still have COVID-19 and uh not be restricted from work. So, Linda, can you tell us a little bit about uh asymptomatic healthcare workers?
SPEAKER_01Leslie, this is one of the major points in the update that came out on September 23rd for interim guidelines for managing healthcare personnel with SARS-CoV-2 infection or either exposure to SARS-CoV-2 infection. So, to read this statement verbatim, the CDC key point is that in general, asymptomatic health care providers who have had a higher risk exposure do not require work restriction regardless of vaccination status if they do not develop symptoms or test positive for SARS-CoV-2. So, what does that mean? That's a long sentence with a lot of information in it. So we recall that the CDC defined higher risk exposure as being in contact with someone who is known or suspected to be COVID positive for a total of 15 minutes in a 24-hour period. So if a healthcare worker is around someone who is COVID positive, and so regardless of their vaccination status, if they don't develop any symptoms or they don't test positive for SARS-CoV-2, they no longer have to isolate and stay out of work for as long as up to 14 days, Leslie. So I think that's one of the major changes that many offices will feel some relief with some of the staffing shortages that we see that continue to be ongoing. So back to you, Leslie.
SPEAKER_00Hey, thanks so much, Linda, for that. And Olivia, if you could give us uh some of the guidelines surrounding return to work criteria with healthcare workers that have SARS-CoV-2 infection with regards to whether they have mild or severe illness and get walk us through that a little bit.
SPEAKER_03Sure, Leslie. And once again, I encourage our listeners to download the document or save it on your desktop. I have the CDC guidance bookmarked so that anytime I'm providing support for a client, I'm pasting it into my response to show this is the most current and it keeps changing, so it's confusing. So for healthcare personnel with SARS CoV-2 infection, if the worker has mild to moderate illness who are not moderately to severely immunocompromised, they could return to work after the following criteria have been met, which is seven days have passed since the symptoms first appeared. If a negative viral test is obtained within 48 hours prior to returning to work, and at least 24 hours have passed since the last fever without using fever-reducing medications, and symptoms such as cough, shortness of breath have improved. Now, the next group is healthcare personnel who were asymptomatic throughout their infection and are not moderately to severely immunocompromised, could return to work if at least seven days have passed since the date of their positive viral test and 48 hours prior to returning to work. And then the final group is healthcare personnel with severe to critical illness who are not moderately to severely immunocompromised, could return to work after the following criteria is met. 10 days and up to 20 days have passed since the symptoms first appeared. And notice the connector, at least 24 hours have passed since last fever without using fever-reducing medications, and symptoms have improved. The test-based strategy is described below for moderately to severely immunocompromised workers can be used to inform the duration of work restriction. So I think we need to keep this document handy because that question will come up a lot to make sure we're in compliance with the latest guidance.
SPEAKER_00Olivia, thank you. And I want to backtrack because I confused myself when I said uh healthcare workers who may be testing positive for COVID-19. You gave us the guidelines for those who test positive. Um, but what I was talking about when I mentioned this to Linda was I wanted to mention the healthcare workers who have had close contact and a high-risk exposure. So they've been in contact with someone who has COVID-19. When we screen our patients, we say, you know, wear a well-fitting mask. Don't come in until after that 10-day period has passed. But for healthcare workers, if you've had a close contact with someone who has COVID-19, you could still come to work. There's no work restriction, but you wear a well-fitting mask, of course, around everyone in every setting at all times. And of course, we're the proper PPE for clinical. I just wanted to make sure that I clarify that. Again, even as uh somebody who's staying on top of this, I confuse myself as I was uh discussing this earlier. So I'm glad that Olivia had a chance to straighten us out on all that. And now what I'd like to do is I'd like to ask Miriam if she could give us an idea, just an overview of uh how we take care of evaluating healthcare personnel with symptoms of SARS-CoV-2 infection. And that regards uh talking about testing. When should testing take place and what kind of testing?
SPEAKER_02Okay. Um, as if we don't already have enough confusion, um, but this is pretty straightforward. Anyone who is a healthcare provider, anybody working in the dental practice, if you have symptoms, whether you think it's COVID or not, you should be tested because we don't want a transmission to be um traced back to your your dental practice. So the new CDC guidance states that, and this actually isn't a big change from before, if you test negative from one viral test and you don't have any symptoms, or you're not considered to be an active case, if you have a negative test, then you're fine. But what tests should you get? Many people have the antigen tests that they got, maybe free from the government, or you buy them in the drugstore. Those are not the most reliable tests. And there are times when the recommendation is to test multiple times with those tests. If you get a negative test, then repeat again to make sure you didn't get a false negative response. The bottom line from the CDC guidance is the best test for a healthcare provider with symptoms is a molecular test, which we commonly known as a PCR test, that you go to your physician, you go to the lab, um, some of the pharmacies are still doing them, um, and you have that test done in the laboratory. And if you test negative, then you may return to work. But it is strongly suggested that you still have a second molecular test at the time of your infection to or when the collection was the sample was collected to confirm that that's not a false negative test. So again, using the home tests or the the antigen test that you can get the results in 15 minutes are not as reliable as the PCR test.
SPEAKER_00Mary, thank you so much. All of this has been is very confusing information. And I know as we are closing this podcast, we always want to bring clarity and simplicity to compliance. This is not a simple thing to follow. It's constantly changing. So uh, in order to make sure we're protecting ourselves and providing the safest dental visit for our patients, download the CDC guidelines from September 2000, uh, September 23rd of 2022. It's the interim infection prevention and control recommendations for healthcare personnel during COVID-19 pandemic. Interim means that they're interim and they're constantly in flux. Uh, in the first paragraph, it does have the link for isolation and work restrictions. And another thing to be closely acquainted with is that COVID tracker, the COVID-19 tracker on CDC, understand community transmission levels versus community levels by themselves. It's two different sets of data that help inform. We are informed in dental health care settings by community transmission. The public is informed by community levels on whether they want to wear a mask in public places like the grocery store or the market or uh bowling alley, movie theater, uh what have you. So, with that, the resources will be on our website at thecompliancedevas.com. And we thank you very much for joining us for this special episode on the CDC Updates.