Covid Policy

Standard Operating Procedures (SOP) Introduction

This document sets out the context of the CODE iComply Standard Operating Procedures (SOP), otherwise known as the ‘C Documents’, including the background on the COVID-19 pandemic and explanation of risks. All information contained within SOP documentation is believed to be current at time of publication, however, the SOPs should be considered “live” documents—meaning that they should be read in conjunction with up-to-date NHS for your nation and recognised guidance (e.g. FGDP). Policies and procedures contained within the SOP should therefore be updated accordingly. CODE understand that this may be frustrating for practices, who are already having to adapt to a new way of working, however, due to the rapid changing nature of the pandemic this is an unavoidable necessity. However, to help practices keep abreast of possible changes, links to “live” guidance has been provided throughout the document where possible and pointers regarding key decisions to be made have been included.

Introduction and Explanation of Risks

Coronavirus disease (COVID-19) is an infectious disease caused by a newly discovered coronavirus. Most people infected with the COVID-19 virus will experience mild to moderate respiratory illness and recover without requiring special treatment. Older people, and those with underlying medical problems like cardiovascular disease, diabetes, chronic respiratory disease, and cancer are more likely to develop serious illness.

The main symptoms:

High temperature
New, continuous cough – this means coughing a lot for more than an hour, or 3 or more coughing episodes in 24 hours
Loss or change to sense of smell or taste

Most people with coronavirus have at least one of these symptoms.

The COVID-19 virus is primarily transmitted between people through respiratory droplets and contact routes. Droplet transmission occurs when a person is in in close contact with someone who has respiratory symptoms (e.g., coughing or sneezing) and is therefore at risk of having his/her mucosae (mouth and nose) or conjunctiva (eyes) exposed to potentially infective respiratory droplets. Transmission may also occur through fomites in the immediate environment around the infected person. Therefore, transmission of the COVID-19 virus can occur by direct contact with infected people and indirect contact with surfaces in the immediate environment or with objects used on the infected person (e.g. thermometer).

Transmission and Infection Precautions

There are various risks of transmitting COVID-19 in the provision of dental services are through direct and in-direct contact, through droplets in the air and through the spray created through Aerosol Generated Procedures (AGPs).

The policies in this SOP aim to mitigate risks of transmission utilising the following precautions:

Contact precautions: used to prevent and control infection transmission via direct contact or indirectly from the immediate care environment. This is the most common route of infection transmission.
Droplet precautions: used to prevent and control infection transmission over short distances via droplets (>5μm) from the patient to a mucosal surface or the conjunctivae of a dental team member. A distance of approximately 1 metre around the infected individual is the area of risk for droplet transmission which is why dental teams routinely wear surgical masks and eye protection for treating patients.
Airborne precautions: used to prevent and control infection transmission via aerosols (≤5μm) from the respiratory tract of the patient directly onto a mucosal surface or conjunctivae of one of the dental team without necessarily having close contact.

iComply C, G and M Documents

To respond to the unique challenges of the COVID-19 pandemic, CODE have created a new document set within iComply. These documents are labelled with the prefix “C” and will be referred to as “C Documents”.

The policies and procedures contained within these new C Documents do not replace previous practice policies, but are to be read as running in parallel with the requirements already established CODE iComply Governance Documents (G Documents) and the CODE iComply Management Modules (M Documents). It is possible, however, that there will be some cases where the requirements between the new C Documents differ from those contained in the G and M Documents. Where this is the case, the practice will follow the most stringent requirement and control measure (this is most likely to be contained within the C Documents). Where there uncertainty as to which procedure or control measure is more stringent, team members should speak to their Practice Manager. Team members must also ensure that they put their own safety and the safety of those under their care at the forefront of their decision-making.

Social Distancing Policy Statement

UK guidelines currently state that to reduce the likelihood of COVID-19 transmission, individuals from separate households should maintain a gap of two metres between each other at all times—this is referred to as “social distancing”. Social distancing will be observed within the practice as much as possible, however, it is recognised that the provision of dental treatment will mean that closer contact is often necessary. Where social distancing cannot be maintained team members will ensure that appropriate personal protective equipment (PPE) is worn in line with current guidance. As far as is possible we will implement physical measures to allow for social distancing by moving non-essential furniture, placing social distancing markers on the floor, and limiting the number of people in the practice at any one time. Measures to mitigate the risks of team members, patients and other visitors to the practice coming closer than two metres will be managed in the Practice Risk Assessment (C 204).

CPR Policy Statement

All team members have been made aware of the impact of COVID-19 on CPR and resuscitation. Whenever CPR is carried out, particularly on an unknown victim, there is some risk of cross infection, associated particularly with giving rescue breaths. Normally, this risk is very small and is set against the inevitability that a person in cardiac arrest will die if no assistance is given. The first things to do are shout for help and dial 999.

The practice follows guidance from the UK Resuscitation Council (RCUK) on conducting CPR/defibrillation.

The guidance as of 31 May 2020 is listed below and is based on the heightened awareness of the possibility that the victim may have COVID-19. This is subject to change and therefore all team members will ensure that they are up-to-date with the current guidance issued by (RCUK).

If you are untrained or unable to do rescue breaths, give chest compression-only CPR (i.e. continuous compressions at a rate of at least 100–120 min-1)
Recognise cardiac arrest by looking for the absence of signs of life and the absence of normal breathing. Do not listen or feel for breathing by placing your ear and cheek close to the patient’s mouth. If you are in any doubt about confirming cardiac arrest, the default position is to start chest compressions until help arrives
Make sure an ambulance is on its way. If COVID 19 is suspected, tell them when you call 999
If there is a perceived risk of infection, rescuers should place a cloth/towel over the victims mouth and nose and attempt compression only CPR and early defibrillation until the ambulance (or advanced care team) arrives. Put hands together in the middle of the chest and push hard and fast
Early use of a defibrillator significantly increases the person’s chances of survival and does not increase risk of infection
If the rescuer has access to any form of personal protective equipment (PPE) this should be worn
After performing compression-only CPR, all rescuers should wash their hands thoroughly with soap and water; alcohol-based hand gel is a convenient alternative. They should also seek advice from the NHS 111 coronavirus advice service or medical adviser

Paediatric advice

The importance of calling an ambulance and taking immediate action cannot be stressed highly enough. If a child is not breathing normally and no actions are taken, their heart will stop and full cardiac arrest will occur.

Doing rescue breaths will increase the risk of transmitting the COVID-19 virus, either to the rescuer or the child/infant. However, this risk is small compared to the risk of taking no action as this will result in certain cardiac arrest and the death of the child.

Chaperoning Policy Statement

Patients will be encouraged to attend the practice alone if possible. Some patients may require a chaperone (for example a child attending with their parent or carer, or an adult with a physical or leaning disability). Chaperones will also undergo the same screen questions as a patient (see C 226 – Patient Screening and Triaging Procedure) and be categorised accordingly (see C 224 – Patient Group Categorisation and Acceptance Criteria). As far as possible, a chaperone should be from the same household as the patient. Chaperones will be asked to leave and wait outside the surgery whilst all procedures are carried out. However, this may not always be possible (for example where the patient is a young child or where the patient would be distressed to be left alone). In cases such as this team members will pay particular attention to the Faculty of General Practice’s guidance which advises that ‘there should be an individual case by case risk assessment of whether parents/carers or guardians should be present in the surgery during treatment and make sure that this is done as safely as possible where this is deemed essential’.