key: cord-0764114-ioas1gr4
authors: Nielsen, Marjean S.; Erickson, Lea Ella; Hume, Wyatt R.
title: Safety, Simulation and Asymptomatic Testing: Navigating the Coronavirus Disease (COVID‐19) Pandemic
date: 2020-07-15
journal: J Dent Educ
DOI: 10.1002/jdd.12332
sha: aa1c13a1880f2cc84d1b4215d08576376d08ed22
doc_id: 764114
cord_uid: ioas1gr4

nan

Given the characteristics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the risk of transmission between individuals in dental education and clinical care settings is high and believed to be primarily via aerosols created when infected individuals speak, sneeze, or cough. Those infected can be highly contagious, with a peak infectivity at or before the onset of any symptoms. 1, 2 Didactic classes, research activities, pre-clinical simulation training, and clinical care all bring individuals together in close proximity. In each situation, respiratory aerosol-mediated transmission is possible. 3 In this paper, we describe the steps taken at the University of Utah School of Dentistry (the School) during the early months of the pandemic to reduce the risks of transmission. Of particular note and potential value to other dental educators are the very early resumption of simulation training activities under closely monitored conditions, and the early adoption of polymerase chain reaction (PCR) testing for virus for all individuals prior to re-entering clinical care settings, funded by University of Utah Health.

To ensure both coordination of planning among the various elements of the School's operations and consistent communications, the Deans' group met for one hour each day beginning on March 3.

On March 23, the School received approval from relevant University authorities to establish a safe environment for re-instituting simulation training. Two "Safety Czars," a DDS clinician faculty member and a PhD virologist faculty member, were appointed, reporting directly to the Dean.

Students, faculty, and staff were required to complete a health self-assessment and temperature check prior to arrival to the building. An overview of the self-assessment is provided in Table 1 . Separate entrances were designated for fully-separated functional spaces within the building for simulation training, administrative support, and patient care at the time of clinic re-opening. An overview of the building's door access guide is provided in Figure 1 .

By mid-April, a phased re-opening of clinical operations began. The patient pool at the School is at high-risk for COVID-19 infection. For these reasons, and despite the likelihood of augmented standard precautions reducing the risk of transmission in the School's clinics to a significant degree, the decision was made in late March to PCR test all asymptomatic patients, providers, and clinical staff.

The University conducted a quality assurance review testing safety standards, consisting of PCR virus and serology testing for providers and staff, comparing those who had contact with patients during emergency care (March 13 through May 18) to those who had no patient contact during that same time. Most test results were negative; one provider tested positive for antibodies to the virus.

It is not yet known whether testing of asymptomatic patients, providers and staff will render the dental setting less likely to be a site for SARS-CoV-19 transmission than the use of symptomatic patient testing and augmented standard precautions alone. The School is now seeking University Institutional Review Board approval to conduct studies to help clarify that question. Table 1 . COVID-19 Entry Self-Assessment and Screening Process All personnel, including faculty, staff, and students, must self-assess their health daily before reporting to the School of Dentistry. They should be able to answer "no" to all the following questions:

 Fever >100.0 0 F  Cough  Sore throat  Shortness of breath or difficulty breathing  Flu like symptoms  Chills  Repeated shaking with chills  Muscle pain  Headache  New loss of taste or smell  Close personal contact (without personal protective equipment; PPE) with a suspected or laboratoryconfirmed COVID-19 patient in the past two weeks  Traveled outside Utah in the past month?

o If "yes," did you serve a 14-day self-isolation upon return? If yes, treat answer as "no".

If the answer is "yes" to any of the screening questions above, the individual may not enter the building. They must contact their supervisor immediately and begin to self-isolate.

If the individual has answered "no" to all screening questions, they may plan to enter the building. Upon arrival, they must sanitize hands and initial the sign-in sheet. Travel within the building should be limited to necessary work areas only.

Thank you. Second floor access: Lab classes, skill maintenance and regional boards.

Third floor access: Administrative activities.

Centers for Disease Control Prevention (CDC)

Interim infection prevention and control guidance for dental settings during the COVID-19 response

Reducing transmission of SARS-CoV-2