You’re Being Screened
Dental customers are looking for signs of 2009 H1N1 flu
BY Nancy Andrews, RDH, BS
The last two infection control columns covered the growing world-wide pandemic of influenza. Since June 2009, more is known about how the disease behaves, what the most serious risks are, the most important precautions and the progress in vaccine development. Even the name of the disease has changed from “swine flu” to “swine-origin influenza A (H1N1) virus infection” to “novel influenza A (H1N1) virus”, to 2009 H1N1. Health advisors have revised their recommendations, and some laws have been passed. For instance, in California, a new OSHA law requires healthcare workers to observe airborne precautions when treating patients with airborne transmissible diseases. It exempts dental offices if they do not treat such patients. This requires screening patients.
Taking precautions
Dental facilities are advised NOT to treat patients with symptoms of influenza and other aerosol transmissible diseases. Healthcare workers who treat patients with 2009 H1N1 influenza A should implement droplet and airborne precautions in addition to standard precautions. Droplet precautions are achievable in typical dental settings and with standard dental supplies. Airborne precautions, however, require N95 masks or respirators, a program for fit-testing the masks, and facilities designed to manage air flow to contain airborne diseases and prevent transmission. These precautions are also required to treat tuberculosis (TB), measles, severe acute respiratory syndrome (SARS), avian influenza A, and other airborne infections. Since most dental facilities are not set up to implement airborne precautions, health authorities advise dental facilities to avoid treating patients with symptoms of influenza and other airborne diseases. Reps should be sharp on screening.
Screening
Infection control starts at the front office. When appointment confirmation calls are made, and when patients enter the office, they should be screened for respiratory illness, including seasonal flu and 2009 H1N1. Patient’s privacy should be protected. Offices should ask patients screening questions to determine if they have flu-like symptoms such as fever, body aches, sore throat, cough, headache, nausea, vomiting or diarrhea.
If the patient answers yes to any of these symptoms, they should be shown sympathy, and thanked for disclosing their symptoms. This is a good time to make sure they see the “Cover Your Cough” or “Respiratory Hygiene/Cough Etiquette” posters (see sidebar). Patients should be offered a tissue, and waste baskets should be visible.
Patients should then be told that the office follows CDC recommendations. Everyone is advised to stay home when they are sick and avoid contact with other people to prevent spreading illness. People with transmissible respiratory illnesses may be treated only in special facilities, under well controlled conditions. Regular dental offices have been advised to postpone treatment on people who are known or suspected to be ill. Patients should be rescheduled, given at least seven days to recover. The patient’s symptoms should be gone prior to the next appointment.
If a patient is very ill, they should be advised to call their doctor or call 911 immediately. If they have any of the warning signs mentioned in the table on page 28, they require urgent medical attention.
Patients with urgent dental needs should be given a mask to wear until the doctor can see them. They should be isolated in a private room, or at least three feet away from others. CDC, state and local healthcare recommendations/regulations should be followed for referring possibly infectious patients for dental treatment in approved facilities.
Offices should also be screening for other respiratory diseases. For coughing patients with potential TB, ask if they have had a cough for more than three weeks. They should also be asked if they have:
- Unexplained weight loss (over 5 pounds)
- Night sweats
- Fever
- Chronic fatigue/malaise
- Blood in sputum when they cough.
Anyone who has a cough for more than three weeks, and who has one of the other symptoms above, must be referred to a healthcare provider for further evaluation, unless they are already under treatment. They should only be treated in approved facilities capable of controlling airborne diseases. In addition to TB, other vaccine preventable aerosol transmissible diseases (such as pertussis, measles, mumps, rubella or “German measles” and chicken pox) should be considered. Patients should be referred for medical evaluation if they have:
- Severe coughing spasms, especially if persistent.
- Fever, headache, muscle aches, tiredness, poor appetite followed by painful, swollen salivary glands under jaw (one or both sides).
Other conditions that may be confused with highly infectious respiratory diseases are: asthma, allergies, chronic upper airway cough syndrome (commonly known as postnasal drip), gastroesophageal reflux disease (GERD), chronic obstructive pulmonary disease (COPD) and emphysema and bronchitis. Some people who take ACE inhibitors develop a dry cough. If you suffer from one of these conditions, be aware that customers and others may suspect that you are contagious during times of heightened awareness of respiratory symptoms.
Avoid being part of the problem
Dental workers and industry representatives should stay home if they are sick. Showing up with symptoms in an office where patients are being screened for respiratory diseases is not the best way to build relationships with customers. Stay away for seven days after symptoms begin, or longer if symptoms remain.
Get vaccinated. All healthcare workers are advised to be vaccinated for both seasonal and 2009 H1N1 influenza and other vaccine-preventable diseases. Since a severe complication of influenza is bacterial pneumonia, consider getting vaccinated for bacterial pneumonia.
When you go out each day, spread the word, not the bugs. Be aware that your customers are screening patients for respiratory illnesses, so everyone should be looking for signs of illness and practicing effective infection control protocol. Dental industry partners can help the effort by being informed, practicing what they preach and providing customers with supplies and other tools such as posters. Go to OSAP.org or cdc.gov/flu for more info.
Sidebar 1:
Signs for reception rooms
- Cover your cough (lists symptoms patients should report to staff)
http://www.cdc.gov/ncidod/dhqp/pdf/Infdis/RespiratoryPoster.pdf
- Cover your cough instructions and fliers
in several languages
http://www.cdc.gov/flu/protect/covercough.htm
Sidebar 2:
Severe flu-related complications
Adults
- Difficulty breathing, shortness of breath
- Chest pain, pressure
- Abdominal pain
- Sudden dizziness
- Confusion
- Symptoms improve, then return with fever, worse cough
- Severe or persistent vomiting
Children
- Fast, troubled breathing
- Bluish skin color
- Dehydration: refusal of liquids, low or no urine output, no or limited tears when crying
- Difficulty waking up, interacting
- Too irritable to be held
- Symptoms improve, then return with fever, worse cough
- Fever and rash, especially if does not blanch
- Severe, persistent vomiting
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