Time To Abandon Enhanced PPE?
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- Published: Sunday, 09 May 2021 19:30
- Written by Chris Tapper
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It’s time to abandon enhanced PPE in dental practice and revert to everyday universal precautions.
The British Association of Private Dentistry is advocating the removal of the requirement for dental professionals to use advanced level PPE, in a document entitled Rationale and Risk Assessment for De-escalation of Enhanced PPE in Dentistry.
The BAPD says there is an ‘overwhelming appetite in UK dentistry’ for the move and points out that there have been no confirmed cases of COVID-19 having been transmitted in clinical dental practice.
The BAPD points out that the need for enhanced PPE has been reduced due to the fall in positive COVID-19 cases, the high level of vaccine delivery in the UK and the reduction in the numbers of those infected being hospitalised leading to a concomitant reduction in the risk of the NHS being overwhelmed by Covid-positive patients.
The BAPD also states that current UK average of 22.1 cases per 100,000 has fallen below the threshold for pandemic status.
The organisation says that there is now substantially more knowledge on COVID-19 than at the outbreak.
The BAPD said “The current documentation available is the PHE COVID-19: Guidance for maintaining services within healthcare settings – infection prevention and control recommendations, which has been adopted by all four countries of the UK.”
“This document, by title, is a recommendation and guidance. We can read and follow this guidance but must also note that one of the opening statements is “Please note that this guidance is of a general nature and that an employer should consider the specific conditions of each individual place of work and comply with all applicable legislation, including the Health and Safety at Work etc. Act 1974.”
“To comply with the above legislation, it is vital to perform a risk assessment, such as the one at Appendix 1 (which must be amended to apply to individual workplaces), to take into account all hazards and possible mitigations. The PHE guidance describes low, medium and high risk pathways.”
The BAPD believes criteria are now outdated due to the increase in vaccine uptake and thorough screenings dental professionals undertake.
The organisations said “The low risk pathway is now more relevant to dentistry.”
“This includes patients/individuals who have been triaged/tested (negative)/clinically assessed with no symptoms or known recent COVID-19 contact/exposure.”
“As such, this means we could use our everyday universal precautions to deal with patients for all types of treatments. This level of PPE has been suitable and sufficient for decades despite various diseases that we have faced.”
The BAPD’s document points out there are several issues associated with the wearing of gowns in practice.
It lists the risk to personnel of self, surface and secondary contamination when doffing gowns, overheating of staff during hot weather, the additional cost of buying and disposing of the gowns, as well as the environmental burden caused by utilising single-use plastics.
“Gowns were primarily used to protect the patient from the clinician not the other way around and have not been proven to be more useful than aprons in covid positive patients, of which symptomatic ones are pre-screened from clinical practice. This, combined with low positive case numbers and self-isolation of contacts of COVID-19 positive patients, negates any putative benefits.”
The BAPD document concluded “We are aware that some regions of the UK have recently highlighted guidance that staff are “no longer required to wear FFP3 masks, gowns etc when undertaking AGPs on patients who have met the criteria for care management via the low-risk pathway, which is now in keeping with national COVID guidance. They have also been advised that where “the low risk pathway is used for elective surgery there will be no requirement for theatre downtime between cases.”
“We believe it is time for a shift in the use of enhanced PPE while still keeping the dental team safe. This needs to start with revisiting the criteria defining low, medium and high-risk pathways - for the reasons outlined above.”
“Consideration needs to be given to balancing living and working with the virus and keeping the team safe.”
“We need realistic and practical guidelines that are easily implemented and will be embraced and easily complied with by the entire clinical team. Individual practice risk assessment must reflect current data and prevalence of the disease in the immediate area and their service users - SOPs should be regularly reviewed and decided at a local level using information locally available.”
Evidence cited by the BAPD concludes that staff are more at risk when doffing the enhanced PPE such as gowns, and compliance is poor when wearing FFP masks routinely.
The paper, written by Jo Russell, Dominic O’Hooley and Bertie Napier for the BAPD has been widely distributed, including to the Chief Dental Officer of England, NHS England and NHS Improvement and the Health Secretary Matt Hancock.
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