Changes to COVID-19 IPAC Guidance from CDHO and RCDSO

Changes to COVID-19 IPAC Guidance from CDHO and RCDSO – What it Means for Your Practice

Michael Streicher

In the ever-evolving landscape of healthcare, guidelines and recommendations are crucial to ensure the safety and well-being of both patients and practitioners. The COVID-19 pandemic has underscored the importance of infection prevention and control (IPAC) measures, particularly in dental settings.   

The College of Dental Hygienists of Ontario (CDHO) and the Royal College of Dental Surgeons of Ontario (RCDSO) have been at the forefront of providing guidance to dental professionals.   

Here at IPAC Consulting, we strive to remain up to date on any changing guidance and provide the best evidence-based advice to our dental clients.  

In this blog post, we will summarize the IPAC guidance changes from CDHO and RCDSO, the recent rescinding of many COVID-19 guidelines for dental practices and what that means for your practices.  

Screening 

 COVID-19 symptom screening has been a fundamental, howbeit tedious aspect of infection prevention in dental offices. Patients and staff alike underwent rigorous screening processes to identify potential cases and prevent the spread of the virus. However, with increasing vaccination rates and declining infection rates, the CDHO and RCDSO, in consultation with the MOHLTC have recently revised their recommendations regarding patient screening. Here is a summary of those changes: 

  1. Dentists now have the freedom to choose their own screening process and are no longer tied to the Ontario MOHLTC Screening Tool. 
  2. Although COVID-19 specific screening has been removed, passive screening (electronic or physical) covering other infectious conditions like influenza, rashes, and infections (ARI screening) should still be part of the routine.  
  3. Any patients that fail the passive screening, should be actively screened by staff either before their appointment or upon arrival. Staff performing active screening must don full PPE including an ASTM 1 surgical mask, isolation gown, eye protection and gloves. The results of the active screening should be recorded in the patient’s chart (pass/fail and any relevant comments). 
  4. A written policy for patient screening for suspected infections remains essential for reducing transmission risks. 

Signage 

Signage has played a crucial role in communicating important information to patients and staff. From reminders about mask-wearing to instructions on hand hygiene, these visual cues have helped reinforce IPAC measures. While some signage related to COVID-19 may no longer be necessary, it’s essential to maintain a level of communication that reflects the current state of the practice and any ongoing IPAC protocols. 

As such, posting signage at the entrance directing all patients to self-assess and self-identify to the reception if they have signs and symptoms of infectious disease, remains in effect.  

PPE (Personal Protective Equipment) 

The use of PPE has been instrumental in reducing the risk of virus transmission in dental settings. The initial guidelines called for extensive and regular use of PPE, including N95 fit-tested respirators, face shields, and fluid resistant gowns. The revised requirements have been tailored to the level of risk in different procedures and patient interactions. This change allows for a more flexible and contextual approach to PPE utilization while maintaining a high standard of infection prevention. 

PPE for patients: Only patients that fail the screening, should be provided with a ASTM 1 face mask, and only if they are able to tolerate it (i.e., children) and it is not contraindicated (i.e., for someone with COPD). Please note patients are no longer required to wear a mask, even if the patient fails the ARI screening. Additionally, patients who screen positive, are no longer required to wear an isolation gown UNLESS AGDPs are being performed.

PPE for administrative staff: Staff are only required to don PPE when actively screening a symptomatic patient.  

PPE for clinical staff: Clinical staff should continue to exercise their professional judgement and select PPE based on their individual point-of-care risk assessment (PCRA).  

Dentists should still don full PPE, including an N95 fit-tested respirator when a patient is suspected of having an illness spread by droplets.  

Hygienists should select a face mask based on the following risk selection matrix provided by CDHO: 

N95 Respirator or Equivalent: For aerosol-generating dental procedures (AGDPs)
ASTM Level 3 – High Barrier: For procedures with heavy spray or spatter, not aerosols. 
ASTM Level 2 – Moderate Barrier: For moderate-risk procedures with moderate levels of spray or spatter, not aerosols.
ASTM Level 1 – Low Barrier: For procedures with minimal to no risk of spray or spatter, and for symptomatic client or staff isolation. 
Surgical Molded Utility Mask: For dry, short procedures that don’t involve fluid, spray, or aerosols. 

In addition, all clinical staff should base their PPE selection on other essential aspects of a point-of-care risk assessment including the patient’s health status and history (passed or failed ARI screening and clinical presentation), and the layout, and design of the operatory (enclosed, ventilation, size etc.).  

Procedures 

From fallow times, to installing physical barriers, to temporarily halting some cosmetic aerosol generating procedures like polishing, dentistry has undergone significant changes to accommodate more stringent COVID-19 IPAC measures.  With the rescinding of COVID-19 guidelines, the CDHO and RCDSO emphasize the importance of maintaining a strong foundation of infection prevention within routine dental procedures.  

Given this perspective, aerosol generating dental procedures (AGDPs) should still be avoided for patients who fail the ARI screening. Ideally, these patients should be deferred, but if the patient condition is urgent, the lowest aerosol-generating options, including using a rubber dam and high-volume suction, and room air purification to mitigate aerosol generation should be implemented.  Ideally, the procedure should still be performed in an enclosed or well ventilated operatory.  

While enclosed operatories are no longer mandatory, clinics with temporary or permanent barriers are strongly encouraged to continue their use, especially during higher risk AGDPs. This ensures an added layer of protection as we navigate the evolving landscape of infection, prevention, and control in dental care.  

The recent changes to COVID-19 IPAC guidance from CDHO and RCDSO reflect the evolving nature of the COVID-19 pandemic and our response to it. As the situation improves and our understanding deepens, a more nuanced and flexible approach to infection prevention and control is emerging. While some guidelines have been rescinded, the core principles of maintaining a safe healthcare environment, vigilant hygiene practices, and patient-centered care remain as steadfast as ever.  

Dental professionals should remain vigilant and reach out to their IPAC Consulting professional with any specific questions or concerns. For more information please visit the RCDSO and CDHO webpages and ipacconsulting.com.