England CDO’s Webinar Clarifies IPC Position On Omicron

England CDO’s Webinar Clarifies IPC Position On Omicron

The emergence of the COVID-19 Omicron variant will NOT delay the UK Health Security Agency’s recent advice and the updated dental Standard Operating Procedures published last week, dental professionals were told last night.

The Chief Dental Officer for England, Dr Sara Hurley, advised dental professionals in a webinar on Wednesday evening  that evidence is ‘Still emerging’ regarding Omicron.

Dr Hurley said “Although there have been a few cases identified, there are not enough to be able to be clear about any change in the disease severity or transmissibility in the United Kingdom.”

“I think we also need to be very cautious about projecting the epidemiology observed in South Africa onto the United Kingdom because the populations are so very different.”

Dr Hurley said that the evidence so far suggests that Omicron spreads in exactly the same was as other variants  “So the same principles apply around the routes of transmission with this variant.”

‘Therefore, appropriate risk management and the use of the full range of the proven IPC measures and  protocols are considered to be effective and appropriate.”

“And with that, the government direction is that the revised IPC guidance specifically produced for  winter 2021-2022 specifically looking at the advent of variants, and more importantly reducing the risk not just to the transmission of COVID but of other respiratory disease.”

“It remains extant,” Dr Hurley said.   

The CDO said that infection, prevention and control (IPC) measures are ‘Exactly spot on’ for the airborne risks that remain, although the guidance is under continual review.  Dr Hurley told the professionals watching the webinar that at a meeting on Wednesday afternoon, it was decided that the IPC guidance would stay in place.

“If however, new evidence emerges, there’s a team on it and they will change the guidance according to the evidence. The guidance will be updated,” Dr Hurley said.

The CDO reiterated the main points of the new SOP document, but also  advised webinar attendees that she had been asked to point out by her  contracting colleagues, “That despite the November IPC and SOP publications, the contractual arrangements that are currently set for quarter three that runs through to December 31st, remain unchanged.”

With regard to the safety of dental personnel, Dr Hurley said “I cannot emphasise enough, the necessity for vaccinations. I think that everything we’re seeing about the new variant points to the fact that the vaccinations and more importantly the booster vaccinations should be a priority for you your staff, and indeed, you should be encouraging patients.”

Oral surgeon Dr Imran Suida echoed the CDO’s remarks that  there is currently insufficient evidence to warrant a change in the IPC guidance although the situation is being closely monitored and the guidance will be kept under continual review.

“It is difficult to show evidence such as low rates of transmission in dental practices because of the way the data was collected, but we know that dental settings have good infection control, and we’ve been doing it well for decades,” Dr Suida added.

Dr Suida  told attendees that a question had been received asking if lateral flow tests could be used to enhance patient risk assessments.

Dr Suida said “Within England, there is no testing requirement in relation to lateral flow tests. The guidance says the use of it isn’t mandatory and therefore is not going to be routinely used. However, it is optional to use lateral flow tests as part of a risk assessment.

“I guess the question that you’d want to ask yourselves, is - how could you utilise lateral flow tests in primary care? And realistically, the only way you could utilise lateral flow tests is to potentially indicate infectivity or to mitigate risk in an asymptomatic patient, on the non-respiratory pathway.”

He added “A lateral flow test is insufficient to downgrade a patient from the respiratory pathway, and only a negative PCR could do this.”

Dr Suida told attendees to the webinar, that the pre-screening of dental patients could be carried by a trained member of the of the reception team, and  it doesn’t have to be a dental care professional.

But he warned “If there is a positive answer to the screening tool, now, a clinical assessment as per the guidance requires a trained and competent dental professional. And ideally,  the best practice would be that this is a dentist or a clinician, and a non DCP receptionist can’t carry out  a clinical assessment and therefore cannot decide where the treatment should be deferred.”

Answering a question about what to do  the situation where a parent or carer accompanying a patient had COVID symptoms, and how to deal with the situation.

Dr Suida said “I think this highlights the importance of screening any accompanying individual.”

“If it’s safe to defer, then do so unless it’s urgent or it may compromise care. But if treatment is required, you could ask if another adult  could accompany the child,  but you have to consider consent.”

He said that clinicians should be aware of the fact that if there is if the child is obviously a household contact of that parent, they may well need a PCR as part of the government guidance. If such a child does need treatment which cannot be deferred, they should be treated under the respiratory pathway, he advised.

Dr Suida also advised clinicians to checking regularly on the Red List countries for any key updates, so information could be  disseminated to dental teams.

Addressing a question about asking patients about their vaccination status, Dr Suida said “Vaccination status can’t be used as a means to any discrimination or refusal of care for a patient. and something that you need to consider is if you need to ask the question, and I think it’s for a valid risk assessment purpose of asking the patient if they’re vaccinated or not, and there’s no issue with this.”

“An example would be in a patient who’s already clinically extremely vulnerable - or as they previously used to call that shielding - they are particularly at high risk of complications from respiratory infections, and if one of these patients is unvaccinated, then their risk status is higher than other patients.”

“And hence, they need a particular extra further protective measures such as separation and time will place patients where possible.”

Addressing a question about the vaccination of dental staff, Dr Suida said “As we have seen in the letter from the Department of Health and Social Care, they are requiring that all individuals carrying out CQC regulated activities must be fully vaccinated by the first of April in England, and this covers the whole of the dental sector, including both NHS and private care, and it includes all workers who have a direct face to face contact with patients.”

He reminded the attendees that “Unvaccinated individuals need to have their first dose by early February in order to have the second dose by the first of April.”

“There may be some exceptions that apply to this and you may have members of your team that you know, that might meet these exception criteria. And it’s very easily Googled as the ‘COVID-19 medical exemptions to healthcare staff vaccination.’”

After the webinar, one dental professional expressed disappointment to GDPUK that no dental nurse appeared to have contributed to the webinar’s content and pointed out that there appeared to be no submitted questions from dental hygienists, who often face challenges when working single-handedly.

Dr Suida said towards the end of his presentation that if a member of staff has a member of a household that is either symptomatic or positive for COVID-19 “That staff member should not attend clinical work until a PCR test is carried out.”

He advised that a staff self-isolation tool for such circumstances is available.

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