No More State Board Rule for COVID-19 Precautions: Now What Do We Do?
On 06/18/2021 the Texas State Board of Dental Examiners (TSBDE) met and agreed to allow the COVID-19 Rule (officially 22 TAC 108.7(16)) expire with no replacement and the suggestion that dentists in Texas look to the CDC for continued guidance. This rule required patient screening, twice daily employee screening, use of N95/KN95 (or substantial equivalent), and so on.
A couple of weeks prior, however, OSHA announced the Emergency Temporary Standard (ETS) to address COVID-19 safety in healthcare settings. The ETS being a Standard has the effect of law and is enforceable as such. We will explore the CDC Guidelines in a moment, but first, let us discuss the ETS.
From OSHA’s COVID-19 ETS Summary: “The virus that causes COVID-19 spreads most commonly through person-to-person contact (within about 6 feet), primarily through inhalation of respiratory particles (droplets and aerosols) produced when an infected person exhales, talks, sings, shouts, coughs, or sneezes.
The ETS is aimed at protecting workers facing the highest COVID-19 hazards—those working in healthcare settings where suspected or confirmed COVID-19 patients are treated. This includes employees in hospitals, nursing homes, and assisted living facilities; emergency responders; home healthcare workers; and employees in ambulatory care facilities where suspected or confirmed COVID-19 patients are treated.”
The ETS “does not apply to non-hospital ambulatory care settings where all non-employees are screened prior to entry and people with suspected or confirmed COVID-19 are not permitted to enter those settings.” The ETS does not seem to prescribe what is necessary for ‘screening’, so it appears dentists have discretion on what your screening process should look like.
So, the Dental Board is giving dentists their brains back to decide how to keep patient safe. OSHA seems to be giving dentists their brains back to decide how to keep employees safe. Doctors, you have some decisions to make.
What is the ‘right’ patient screening process for your office setting? Is it a verbal inquiry? A written inquiry? A patient response to your appointment confirmation software? Does it involve a temperature check? You decide.
On another note, if you make the wrong choice, you can always change course. Meantime, “OSHA will use its enforcement discretion to avoid citing employers who are making a good faith effort to comply with the ETS.”
If you were excited that you no longer have to screen patients (by TSBDE Rule) it appears it is still necessary to ensure compliance with OSHA’s ETS.
The ETS exempts fully vaccinated workers from masking, distancing, and barrier requirements when in well-defined areas where there is no reasonable expectation that any person with suspected or confirmed COVID-19 will be present.
Click here to read the full text if the ETS applies to your dental practice.
On another note – last year when the TSBDE required the use of N95/KN95 or substantially equivalent respirators it triggered the application of OSHA’s Respiratory Protection Program under 29 CFR 1910.134. It is nice to see some clarity, albeit quite late in the game, but nonetheless, OSHA came up with “mini-RPP” requirements (29 CFR 1910.504), which require (only) employee training and user seal checks (no fit testing, no medical evaluation, and no written respiratory protection program (RPP), which I provided for each of my clients last year.
The mini-RPP applies when the use of a respirator (N95/KN95) is not required. Well, since the TSBDE no longer requires respirators, this seems to apply to a large majority of dental offices.
To say it was a struggle for dental offices to comply with OSHA’s Respiratory Protection requirements (i.e. medical evaluations and fit testing) is a gross understatement. The ‘mini RPP’ is a breath of fresh air; it is doable (heck you have already done it).
What About the CDC Guidelines?
As a reminder, the CDC Guidelines are recommendations based on scientific data. These guidelines may become law when adopted by the state dental board, OSHA or other regulatory agency.
Let’s look at the COVID-19 Guidelines for dental offices (current as of 06/20/2021):
CDC recommends using additional infection prevention and control practices during the COVID-19 pandemic, along with standard practices recommended as a part of routine dental healthcare delivery to all patients. These practices are intended to apply to all patients, not just those with suspected or confirmed SARS-CoV-2 infection
· Consider if elective procedures, surgeries, and non-urgent outpatient visits should be postponed in certain circumstances.
· Implement Teledentistry and Triage Protocols (signed into law, but not yet allowed in Texas quite yet)
· Screen and Triage Everyone Entering a Dental Healthcare Facility for Signs and Symptoms of COVID-19
· Monitor and Manage Dental Health Care Professionals (DHCP)
· Create a Process to Respond to SARS-CoV-2 Exposures Among DHCP and Others
· Implement Universal Source Control Measures
· Encourage Physical Distancing
· Consider Performing Targeted SARS-CoV-2 Testing of Patients Without Signs or Symptoms of COVID-19 (not an option for Texas dentists)
· Implement Administrative Controls and Work Practices
· Implement Universal Use of Personal Protective Equipment (PPE)
· PPE Supply Optimization Strategies
· Hand Hygiene
· Equipment Considerations
· Optimize the Use of Engineering Controls
· Environmental Infection Control
· Sterilization and Disinfection of Patient-Care Items
· Education and Training
Click here to read the details of these recommendations.
There are recommended infection prevention and control practices when providing dental healthcare for a patient with suspected or confirmed SARS-CoV-2 infection, but so few dental offices care for patients in this situation I won’t review them here.
I just love (and appreciate) that the Texas Dental Board gave dentists their brains back. By that I mean that a dental license is a recognition by the state that the dentist is qualified to determine how best to care for their patients and how to protect them against avoidable infections. This has always been the law of the land and how it works. The Board’s action/inaction is not permission to go back to normal but rather IS permission for you (dentists) to make decisions on how to proceed. As always, stay informed, be judicious, make good choices, and change course when the situation dictates – you got this!
If you need a sounding board, it is what I do for my clients. Don’t be afraid to reach out if you need to bounce your ideas off someone outside your practice. I won’t tell you what to do, but I will help you better understand the pros and cons of the decisions before you, so you can make better-informed decisions for your dental practice. Call 817-755-0035 to schedule a time we can talk.