This policy was developed for in-house use by Lowell, Nashua & Chelmsford Oral Surgery Associates and generously shared (March 6th, 2020)

The purpose of this training is to provide you with information about the Coronavirus (COVID-19), identify symptoms, and to review infection control and prevention strategies to protect you and our patients. Per the CDC, the risk remains low, however this could change at any time. If the status changes, we will be providing you with a plan.

A Brief Coronavirus Background

The Coronavirus was first detected in China and now has been detected in almost 70 locations internationally, including in the United States. The virus has been named “SARS-CoV-2” and the disease it causes has been named “coronavirus disease 2019” (abbreviated “COVID-19”).

Coronavirus (COVID-19) Symptoms

Signs and symptoms of COVID-19 may appear 2 to 14 days after exposure and can include:

Shortness of Breath

Situation in U.S.
Imported cases of COVID-19 in travelers have been detected in the U.S.
Person-to-person spread of COVID-19 was first reported among close contacts of returned travelers from Wuhan.
During the week of February 23, CDC reported community spread of the virus that causes COVID-19 in California (in two places), Oregon and Washington. Community spread in Washington resulted in the first death in the United States from COVID-19, as well as the first reported case of COVID-19 in a health care worker, and the first potential outbreak in a long-term care facility.

United States Statistics (3/4/2020):
Total Coronavirus (COVID-19) Cases:
Total cases: 99
Total deaths: 10
States reporting cases: 13
Distribution of Transmission:
Travel-related: 30
Person-to-person spread: 20
Under Investigation (they don’t know yet): 49

Current risk assessment:
For most of the American public, who are unlikely to be exposed to this virus at this time, the immediate health risk from COVID-19 is considered low.
People in communities where ongoing community spread with the virus that causes COVID-19 has been reported are at elevated, though still relatively low risk of exposure.
Healthcare workers caring for patients with COVID-19 are at elevated risk of exposure.
Close contacts of persons with COVID-19 also are at elevated risk of exposure.
Travelers returning from affected areas: China, Hong Kong, Iran, Italy, Japan and South Korea, where community spread is occurring also are at elevated risk of exposure.

A Review of Standard Precautions/Infection Control/Prevention Practices
Hand Hygiene
Alcohol-Based Hand Sanitizers
Alcohol-based hand sanitizers are the most effective products for reducing the number of germs on the hands of healthcare providers, and is the preferred method for cleaning your hands in most clinical situations.
When using alcohol-based hand sanitizer:
Put product on hands and rub hands together
Cover all surfaces until hands feel dry
This should take around 20 seconds
Washing with Soap and Water

Wash your hands with soap and water whenever they are visibly dirty, before eating, and after using the restroom
When cleaning your hands with soap and water, wet your hands first with water, apply the amount of product recommended by the manufacturer to your hands, and rub your hands together vigorously for at least 15 seconds, covering all surfaces of the hands and fingers.
Rinse your hands with water and use disposable towels to dry. Use towel to turn off the faucet.
Avoid using hot water, to prevent drying of skin.
If worn properly, a facemask helps block respiratory secretions produced by the wearer from contaminating other persons and surfaces (often called source control).
How to Wear a Mask Properly
Wash your hands before putting the mask on.
The mask fits snugly over the face.
The colored side of the mask faces outwards, with the metallic strip uppermost.
The strings or elastic bands are positioned properly to keep the mask firmly in place.
The mask covers the nose, mouth and chin.
The metallic strip molds to the bridge of the nose.
Try not to touch the mask once it is secured on your face as frequent handling may reduce its protection. If you must do so, wash your hands before and after touching the mask.
When taking off the mask, avoid touching the outside of the mask as this part may be covered with germs.
After taking off the mask, fold the mask outwards (i.e. the outside of the mask facing inwards), then put the mask into a plastic or paper bag before putting it into a rubbish bin with a lid.
A surgical mask should be discarded after use and under no circumstances should it be used for longer than a day. Replace the mask immediately if it is damaged or soiled.
Masking and Separation of Persons with Respiratory Symptoms
Offer masks to persons who are coughing. Either procedure masks (i.e., with ear loops) or surgical masks (i.e., with ties) may be used to contain respiratory secretions (respirators such as N-95 or above are not necessary for this purpose).
Respiratory Hygiene/Cough Etiquette
The following measures to contain respiratory secretions are recommended for all individuals with signs and symptoms of a respiratory infection.
Cover your mouth and nose with a tissue when coughing or sneezing;
Use in the nearest waste receptacle to dispose of the tissue after use;
Perform hand hygiene
Droplet Precautions
Observe Droplet Precautions (i.e., wearing a surgical or procedure mask for close contact), in addition to Standard Precautions, when examining a patient with symptoms of a respiratory infection, particularly if fever is present.
Perform hand hygiene, then put on clean, non-sterile gloves upon entry into the patient room or care area. Change gloves if they become torn or heavily contaminated.
Remove and discard gloves when leaving the patient room or care area, and immediately perform hand hygiene.
Additional Tips
The Center for Disease Control (CDC) recommends the following additional prevention tips:
Avoid touching eyes, mouth and nose
Don’t share personal items such as water bottles
Avoid close contact with individuals who are symptomatic
Stay home when you’re sick, and remain home for at least 24 hours after you no longer have a fever or signs of a fever, and your respiratory symptoms are improving.
Cover your cough or sneeze with a tissue, and immediately discard the tissue in the trash