This framework follows on from the UK Health Security Agency having replaced their previous UK IPC Guidance with new COVID-19 specific advice. Additionally, a new National Infection Prevention and Control Manual for England has been published for all settings where NHS services are delivered. The Manual is intended to offer the principles for safe care for patients, staff and, in particular, vulnerable groups.
The intention is a move towards more routine infection and prevention and control across healthcare, including in dentistry. The dental framework emphasises the importance of practice-level risk assessment to guide approaches to IPC, and PPE usage in particular.
There remains a focus on encouraging patients with respiratory signs and symptoms to contact practices in advance and not to attend if unwell or infectious and indeed, for practices to establish patient status ahead of attendance.
The framework sets out a revised approach to physical distancing, which is no longer required unless suspected or confirmed covid positive patients are attending the practice. In relation to cleaning, practices are advised to return to established pre-pandemic cleaning routines with enhanced cleaning after known infectious patients have attended.
The broad intention to ease controls has been welcomed by many members, although the practical consequences of the changes are likely to be limited given the expectation that patient screening continues, with potentially different pathways for patients with respiratory symptoms.
The new guidance has also raised a number of questions about the practical approach to be adopted by practices in England, and we have raised these with NHS England to seek clarification. We have raised questions, including:
When higher level mask wearing remains appropriate – as some members are concerned that untriaged patients in pain may present in areas where mask wearing is no longer required
The approach to risk assessment and practical impact of assessments – for instance, if the practice risk assessment shows that some/most patients are not on the respiratory pathway, would the practice be safe to use pre-covid PPE?
Expectations around screening and triaging of patients prior to attendance - how can a practice separate respiratory/non-respiratory pathway patients without screening? And if screening does not establish any concerns, can practices use pre-covid approaches to IPC and PPE?
We will update members as we receive further clarity on these and other issues.