This weekend saw the opening of urgent dental centres (UDCs) in five locations throughout Northern Ireland. Philip McLorinan describes what it's like to work in one of these clinics.
The centre I was allocated is located within the Belfast Trust area. These clinics are the result of a huge collaborative effort from across the dental profession, including general dental, hospital dentistry, the community dentistry service (CDS), NIMDTA and the HSCB. It is amazing to see these sectors pull out all the stops to ensure patients who are experiencing dental pain, swelling, trauma or bleeding can receive the care they require during this extremely hazardous and difficult time.
The facilities provided by the CDS are excellent both for the patients and staff. The dental equipment is well stocked and the first delivery of personal protective equipment (PPE) seems to be satisfactory for the early stages of the clinics.
However, while the facilities provided are impressive, there is still a considerable onus on us all to ensure that we keep ourselves and our patients safe through thorough preparation and post-shift sanitising.
Here are the lessons I've learnt and my tips for working in the UDCs.
Before your shift in a UDC
The day before you start working in a UDC make sure you keep hydrated. Wearing the PPE, including the FFP3 mask, will not only protect you but will drain every ounce of moisture from your body. So keep your fluids up.
Sort out your clinical kit. Prepare lightweight scrubs as it gets very hot. Consider bringing two pairs for a full session. Bring footwear that can be wiped clean or have disposable shoe covers. No holes, laces, or any elasticated bits that can be exposed and allow aerosols to be absorbed.
Wear ordinary prescription glasses that you are happy to wipe, wipe and wipe again. I have decided not to bother with my loupes in these clinics as there's no way can I guarantee they are clean enough after aerosol use, and I can't see myself checking for crown margins or MB2 canals.
Bring a clean pillowcase to your shift with your scrubs and work shoes in it. After the session place your used scrubs into the pillowcase and transfer the whole lot immediately to your washing machine when you get home. Avoid bringing a plastic bag.
Bring a packed lunch, water bottle and plenty of snacks to keep up your energy.
wearing full COVID19 PPE for aerosol-producing procedures. This includes a
full surgical gown, face visor and FFP3 mask, covered by another layer of a
fluid-resistant surgical mask.
During your shift (9am-5pm)
You'll start the day by meeting your team. Each team consists of five dentists- two in each surgery, one treating, one assisting and one triaging calls. There will be at least one dental nurse outside the room acting as a runner and assisting with x‐rays, equipment etc. They will also escort patients to and from the surgery whilst minimising any risk of viral transmission.
Once the triaging of calls takes place, you will all discuss the cases and determine if they meet the referral criteria and if so, appointments are arranged. The referring dental practice will provide information such as previous x‐rays, medical history and dental history by email. It is key to the success of this system that general practices remain accessible to their patients to give appropriate advice and triaging for dental emergencies.
Once you receive the triage information, plan the equipment that you are going to need and work with the support nurses to ensure that it is (as much as is feasible) ready in advance. This is to make the most efficient use of your clinical time whilst in full PPE. In terms of patient session time, we are currently estimating about one hour per patient, and longer if aerosols are generated as the decontamination protocols are extensive.
The PPE you wear is determined by each UDC protocol, however, here's a very useful video guide to donning PPE. Follow local guidance for decontamination of the clinical environment depending on whether or not aerosols were used. You'll be amazed at how many nooks and crannies there are to clean! After the clinical encounter, ensure safe removal of your PPE. Again, here's a video guide to doffing PPE. Get ready: a full treatment encounter and decontamination is a workout in itself!
Before you finish
Keep drinking plenty of water throughout the day. Hydration is key. Write up your clinical notes in a designated room away from the clinical environment. We are fortunate to have OPT facilities available at our centre, and clinicians are asked to forward any previous radiographs at triage stage. Use hand sanitiser as often as you can and maintain social distancing where possible.
At the end of the shift change out of your scrubs and place them in your pillowcase for transporting home. Clean your mobile phone and shower if there's one available.
When you get home
It is important to establish an after work washing and sanitising routine.
Clean your car when you arrive home. Wipe down the steering wheel, gear stick, controls and door handles. Try and avoid touching anything if you don't need to. For example, knock on your home door and have someone else open it if possible. Avoid physical contact with anyone in your household at this stage. Throw your pillowcase containing your scrubs etc. straight into the wash and sanitise your hands again. Grab another shower and change into fresh clothes. Sit down and relax, rehydrate and moisturise.
Working within an urgent dental centre is obviously a worrying prospect for many within the dental profession. From what I have experienced however, the powers that be have done everything possible to ensure a safe working environment for all.
The next few days will see an increase in demand on this service from general practitioners and their patients. I trust that understanding and patience will continue during the early stages of the urgent dental centre service until they are fully staffed and working towards capacity.
Stay safe (and stay hydrated).