Sarah Hurley, chief dental officer for England, and Lisa Richie, head of infection prevention control for NHS England, recently published a new NHS dentistry and oral health update which focused on “infection prevention and control” as part of the “transition back to pre-pandemic IPC measures”.
To aid this transition they foreground, ‘The NHS England Infection Prevention and Control Manual’ and its accompanying “dental framework for identifying hazards and risks with guidance on measures that should be maintained as we move to new, improved and safer ways of working”.
“In making a safe transition and balancing risks appropriately the framework follows the now familiar hierarchy of controls format. It provides a consistent handrail applicable to the generic dental practice environment in the management of respiratory pathogens.
“Practices will be very familiar with the Standard Infection Prevention and Control measures detailed in the manual and should note the on-going additional transmission based precautions which should be adopted for the management of higher risk.”
“Of course, we must remain vigilant to the risks and impacts of existing and emerging pathogens and consider the associated measures for their management in dental practice settings. However, practices may also wish to take local advice from Regional IPC leads and their Regional Public Health Team.”
Infection prevention control as we live with Covid-19
Discussing the future and changing needs of the UK as the country continues to live with Covid, the update explains, “The UK Health Security Agency (UKHSA) have replaced their previous UK IPC Guidance with new Covid-19 pathogen specific advice for health and care professionals. This new advice should be used alongside the National Infection Prevention and Control Manual (NIPCM) for England and applies to all NHS settings or settings where NHS services are delivered. The NIPCM also contains guidance on the application of the hierarchy of controls in dental setting.”
This guidance features several changes including:
- “Protecting your patents, your staff and yourself: Risk assessment via the dental framework and application of the hierarchy of controls, as detailed in NHS IPC Manual.
- “Patient screening: Screening questions are no longer required prior to attendance.
- “Public messaging: Practice information for patients should encourage patients with any respiratory signs and symptoms to telephone for advice. Patients should not visit if unwell/infectious without telephoning the practice for advice.
- “Physical distance: No longer required unless suspected /confirmed case attending. In these cases one metre social distancing required, ideally look for timeslots at the end of sessions to minimise contact with other patients/staff.
- “Cleaning: Practices are to return to the well-established pre-pandemic cleaning routines. Enhanced cleaning only required after known infectious patients have attended
- “Staff testing: No change – all staff should continue to test twice a week with LFDs.”
Monkeypox CAS alert
Cases of monkeypox have “increased recently but the risk to the UK population remains low”. But “community transmission is occurring in the UK with multiple generations of spread”. In general, the illness appears to be mild and consistent with available “information about the West African clade”.
They stress that “Anyone can get monkeypox. Currently most cases have been in men who are gay, bisexual or have sex with men, so it's particularly important for these people to be aware of the symptoms.”
If patients experience a rash with blisters and either:
- Have been in close contact, including sexual contact, with someone who has or might have monkeypox (even if they've not been tested yet) in the past three weeks
- Have been to west or central Africa in the past three weeks
These patients should be tested and assessed according to UKHSA guidance. Patients unable to contact a sexual health clinic should call 111 for guidance.
Ukrainian citizens arriving in the UK
The update concludes by providing information for primary care professionals for the treatment of patients from the Ukraine.
UKHSA has created a guide as a resource to aid with “patients ordinarily resident in Ukraine who have arrived in the UK in response to the conflict between Ukraine and Russia. Individuals may be eligible for reduced charges or free care for dental services and information about this is available in other languages.
“Families and individuals arriving in England supported by UK Visas and Immigration (UKV&I) under section 95, are usually issued with HC2 certificates within two weeks of their arrival. If the patient has not yet received their HC2 certificate and is unable to provide evidence of exemption, then you will need to include the clarification on access to dental care and the agreed approach to dental charge exemptions process:
- “Do not refuse treatment
- “Put an X against the ‘No’ option in the Evidence of remission seen’ box on the FP17 PR “form and Dental Activity claim
- “Ask the patient to sign the declaration on the FP17 PR form”
Hurley and Richie also “remind colleagues that to be most effective for the people who need it, these support efforts must be properly co-ordinated, as part of the overall UK Government-led response. As such, we ask that, rather than trying to contact Ukrainian or neighbouring authorities directly with offers of support, NHS organisations direct their contributions to England.incident14@nhs.net.”
Also discussed in the update:
- Flexibility in Dental Speciality Training: Aiming to invite educators and postgraduates in training to complete a short survey to develop training opportunities further.
- Next Steps for Integrating Primary Care: Following the release of Dr Claire Fuller’s report on Next Steps for Integrating Primary Care improvements to utilise the Integrated Care system and primary care in tandem has been suggested.
- Help develop the new Booking and Referral standard: Encouraging dental professionals to provide feedback on the new Booking and Referral Standard.
- Health and Social Care Panel - Virtual Honours Festival: As part of the Queen’s Platinum Jubilee an event is being held on the 15th of June to hear from a variety of inspirational honours recipients.
- Free and rapid coaching available for primary care dental colleagues: Following the success of the ‘Looking after you’ webinar appointments are now available with coaches to discuss “your wellbeing, the team you lead or your career”. All the coaching is free and confidential.