Australian Dental Association Victorian Branch Inc

COVID-19

The COVID-19 pandemic has impacted the entire community, including dental practices. The following information and resources are intended to assist your practice in managing COVID-19.

Stage 3 'stay at home' restrictions

UPDATE - 15 JULY 2020

On Sunday 12 July we advised all members working in metropolitan Melbourne and the Shire of Mitchell to move to Level 2 dental restrictions, recognising the increased risk of transmission in the community. The past two days have seen a big jump in the number of COVID-19 cases with an unknown source of transmission, which is particularly concerning. This reinforces our recommendation to work at Level 2 restrictions.

In a briefing the ADAVB attended yesterday Health Minister Jenny Mikakos advised that 342 health care workers have tested positive since the pandemic commenced. Most of these were contracted in the community, but some are cases of healthcare setting-based transmission. This aligns with what we know about COVID-19 in the dental setting, with several instances of COVID-19 affecting dental practices in Victoria. To date, none of these has involved transmission in the clinical setting, with several cases involving members of the dental team contracting COVID-19 from other sources in the community, and one case of a patient who attended a dental appointment and subsequently tested positive.

We received a letter from the Chief Health Officer Professor Brett Sutton yesterday. He has noted the importance of avoiding procedures that generate contaminated aerosols unless rubber dam is used, and he has advised public dental services in metropolitan Melbourne and the Shire of Mitchell to operate at a minimum of Level 2 dental restrictions. The ADA Infection Control Committee met last night and supports the recommendation to maintain Level 2 dental restrictions for metropolitan Melbourne and the Shire of Mitchell. Although the government has not mandated Level 2 restrictions for the private sector, we are strongly encouraging all dental practices in metropolitan Melbourne and the Shire of Mitchell to continue to work at Level 2 restrictions during this period of heightened risk for the safety of their staff and patients. As the situation is moving quickly It is also recommended that continual risk assessments are done based on what is happening in your local area.

There are several local government areas where the number of active cases of COVID-19 is high:

Moonee Valley 153 active cases per 100,000 people
Melbourne 124 active cases per 100,000 people
Hume 110 active cases per 100,000 people
Wyndham 91 active cases per 100,000 people
Brimbank 73 active cases per 100,000 people
Maribyrnong 57 active cases per 100,000 people
Moreland 53 active cases per 100,000 people.

Dental practices in these locations should be vigilant with their screening and infection control processes and minimise aerosol generating procedures.

Local transmission

Most cases of COVID-19 continue to involve transmission in existing clusters, however community transmission from unknown sources is increasing. It is therefore important to stress to all members of the dental team the fundamental measures to take outside of the dental practice to stay safe:

Maintain physical distancing of at least 1.5m from others
Practice good hygiene, including hand washing and sanitising, particularly when shopping or in external environments
Practice good cough and sneeze etiquette – cough or sneeze into a disposable tissue, throw it away and wash your hands
If you are feeling unwell, get tested, stay home and avoid contact with others
Take care wherever you go and assume that other people carry the virus
Encourage your staff members to pass this advice on to their family and friends.

Dental practice setting

It is now apparent that any member of the dental team could contract COVID-19 and bring it into the dental practice whilst they are asymptomatic, and risk spreading it to other members of the team.

Ensure that team members always maintain adequate distancing when they are not wearing face masks
Consider staggering meal breaks to minimise the number of staff in common areas
Do not share drink bottles, glasses, crockery, or cutlery in the workplace, and ensure there is somewhere for staff to wash and dry their own items
Review processes where members of the team may share or touch the same item in the practice – for example telephones, keyboards, photocopiers, EFTPOS machines
Ensure that staff maintain good hand hygiene in these situations
Provide a physical barrier between patients and reception staff, or provide reception staff with face masks.

DHHS request for support with contact tracing

Following the excellent response from members to the request for assistance with COVID-19 testing. the Department of Health and Human Services (DHHS) is now seeking assistance from qualified dentists to provide support for contact tracing as part of the COVID-19 response. As part of this role, you may be required to work from DHHS head office, 50 Lonsdale Street, Melbourne. To register your interest, please contact Alliedhealthworkforce@dhhs.vic.gov.au.

UPDATE- 14 JULY 2020

The Royal Dental Hospital of Melbourne has moved to Level 3 dental restrictions from today for the next two weeks.

UPDATE - 12 JULY 2020

With COVID-19 cases continuing to increase across Victoria over the past week, ADAVB is now recommending that all dental practices in metropolitan Melbourne and the Shire of Mitchell move to Level 2 dental restrictions from Wednesday 15 July 2020. Dental Health Services Victoria has made the decision to move to Level 2 dental restrictions from Monday 13 July 2020.

Although overall community transmission remains relatively low, there is now growing concern of an increased risk of an asymptomatic patient attending a dental appointment. The number of active and new cases is different across Melbourne which may lead some dentists to question whether Level 2 is appropriate in their location. The Stage 3 ‘Stay at Home’ restrictions apply across all of Melbourne regardless of the relative case numbers because it is considered necessary to restrict movement of people across Melbourne to prevent further transmission of COVID-19, and for that reason we are recommending that Level 2 dental restrictions apply across metropolitan Melbourne and the Shire of Mitchell.

We recognise that this is a difficult decision for our profession, but we have an obligation to safeguard the health and wellbeing of our members and their staff and patients, and the dental profession has a role to play in helping the community to manage this pandemic. Level 2 dental restrictions help to minimise the risk of transmission whilst maintaining access to necessary dental care for the community.

HR Advice

The decision to move to Level 2 restrictions is likely to have HR implications for members. We are working with HR Assured to ensure that they have updated advice for members. A wide range of HR information is available here: www.ada.org.au/Covid-19-Portal/Dental-Professionals

Regional Victoria

If your practice is outside of metropolitan Melbourne or the Shire of Mitchell, then Level 1 dental restrictions still apply. However, practitioners in regional Victoria should continue to monitor their local situation to determine whether Level 1 remains appropriate for them.

Screening

It is a timely reminder to ensure staff are adequately prepared to screen patients before they attend the clinic. This should be done by phone prior to the appointment and in person on arrival. Patients should be reminded that they should not attend their appointment if they are feeling unwell or exhibiting any symptoms of COVID-19, and that they should get tested.

Facemasks

The Victorian Government PPE Taskforce is now recommending that for metropolitan Melbourne and Mitchell Shire health services, it is reasonable for:

staff to wear a level 1 or type 1 surgical mask in public facing areas – particularly where adequate social distancing is not possible.
patients to wear face masks in these same environments.

Based on this guidance, ADAVB recommends that staff in public facing areas such as reception should wear a face mask where distancing is not possible. If it is not possible to provide adequate distance between patients in the waiting room, then patients should also be provided with a face mask.

What is community transmission?

Community transmission is where there are large numbers of local transmissions occurring and a direct source of exposure cannot be identified. This differs to local transmission, where a person acquires COVID-19 locally, and a direct source may or may not be identifiable.

In Victoria over the past 14 days, there has been 1532 new cases of COVID-19. Of these, 21 (1.4%) are from returned overseas arrivals, 609 (39.8%) are linked to existing outbreaks or known cases, 270 (17.6%) are classified as community transmission and 632 (41.3%) are still under investigation. It takes the public health team some time to track the source of transmission which explains the high number of cases under investigation. The majority of these cases under investigation are eventually linked to existing clusters.

Victorian Government Business Support Grant

Businesses operating within metro Melbourne and Mitchell Shire affected by the return to Stage 3 Stay at Home restrictions may be eligible for a one-off, $5000 grant through the expanded Business Support Fund.

More information: www.business.vic.gov.au/support-for-your-business/grants-and-assistance/business-support-package/business-support-fund

Update - 8 July 2020

Following the announcement yesterday of a move to Stage 3 ‘stay at home’ restrictions for metropolitan Melbourne and the Shire of Mitchell, the ADAVB is discussing with the Chief Health Officer the implications for dental practice and whether there is a requirement to move to Level 2 dental restrictions. On the advice of the ADA Infection Control Committee, members should prepare for the likelihood of an imminent move to Level 2 restrictions in metropolitan Melbourne and the Shire of Mitchell. We will continue to provide updated advice to members when it becomes available.

For the time being, we recommend that dentists assess the risk in their practice and move to Level 2 restrictions if they believe that move is warranted. Things to consider when assessing risk include:

Practice location with respect to the number of active cases in your area (refer to the map below)
Patient and staff wellbeing, noting that the risk of serious illness increases in older people and those who are medically compromised
Facility and clinic layout to allow adequate distancing.

Although the number of cases of community transmission remains relatively low, there is the potential for an asymptomatic patient to attend for treatment. For this reason, we recommend that rubber dam be used for all aerosol-generating procedures, and where rubber dam cannot be used, that you consider postponing that treatment.

For dental practices outside of metropolitan Melbourne and the Shire of Mitchell, Level 1 dental restrictions continue to apply, and we don’t anticipate any changes at this stage for these areas.

Is this recommendation mandatory?

The ADAVB is not the regulator, so this recommendation is not mandatory. We recognise that this situation is rapidly evolving across Victoria and the risk is different in different parts of the state. If Level 2 restrictions become mandatory, it will be on the order of the Victorian Government.

The next six weeks are going to be tough for all Victorians, and we understand the impact this will have on you, your staff and your patients. We are in the middle of a public health crisis and the health and safety of the community is paramount in the response by the dental profession. We trust that you will exercise sound judgement in the way that you continue to provide dental treatment to your patients.

Travel out of Melbourne

With the introduction of Stage 3 'Stay at Home' restrictions across metropolitan Melbourne and the Shire of Mitchell, travel outside of Melbourne has been restricted. The ADAVB has confirmed that dentists and specialists who live in Melbourne but have their main practice or satellite practice outside of Melbourne are permitted to travel to that practice location for the purposes of delivering dental services.

NSW border closure

The Victorian and NSW governments closed the border between the two states from 11:59pm Tuesday 7 July 2020. We understand that many dental practices in Victoria’s north see patients from NSW. We are currently seeking advice from the Health Minister’s office about what this border closure means for those people needing to seek dental treatment, and we have strongly advocated that patients should be allowed to travel to Victoria to seek dental treatment. We will provide further updates when more information becomes available. It is expected that people will be able to cross the border to access essential health services, and we expect that this will include dental services. Patients can apply for a permit to travel across the border from Service NSW.

Up-to-date information on activity restrictions is available on the Department of Health and Human Services website.

Refer to the ADA’s COVID-19 web page for further information on COVID-19 guidelines for dental practices, and information about PPE and stock availability.

Resources

The following resources are based on the current advice available and will be reviewed and updated as required. Make sure you continue to visit this site to ensure that you have the most up-to-date information and resources.

Managing COVID-19 Guidelines: A guide to managing COVID-19 in your practice.
Dental Service Restrictions in COVID-19: A framework outlining the ADA's recommendations in relation to the continuation of dental services.
Exposure response plan: Provides guidance for dental practices in dealing with a possible exposure to COVID-19.
Practice policy COVID-19 : Provides guidance on COVID-19 risk management in the practice.
Dental practice COVID-19 information for patients template: Can be used at the reception desk and also when confirming patient appointments to reduce the risk of contact with suspected cases of COVID-19.

Advocacy and action

The ADA and ADAVB have worked tirelessly to represent and support members through the COVID-19 pandemic. An outline of the action we’ve taken as the situation unfolded can be viewed below:

ADA and ADAVB action
Advocacy timeline (to 1 July 2020)
Support summary (to 1 July 2020)

Advice and support

Victorian Department of Health and Human Services

List of COVID-19 testing clinics/assessment centres
COVID-19 public enquiry hotlines:
- National: 1800 020 080
- Victorian: 1800 675 398
COVID-19 clinical advice hotline (Victorian Department of Health and Human Services):
- Ph: 1300 651 160, 24 hours a day. Choose the ‘Specialist Medical Advice’ option. Pending demand, you may be asked to leave a message for return phone call.

LifeWorks ADAVB member assistance program

Members can access free counselling on personal or work issues with our member assistance program provided by LifeWorks. To make an appointment, or for phone counselling 24/7, call 1300 361 008.

HR information, templates and FAQs

Australian Dental Assocation: www.ada.org.au/Covid-19-Portal/Dental-Professionals

Financial support

Financial support measures for businesses
Financial support measures for individuals and households
Australian Government fact sheets on the economic response package.
Australian Dental Assocation: www.ada.org.au/Covid-19-Portal/Dental-Professionals

Updates

Please check your email inbox for both ADAVB and ADA updates.

Further information

As the situation can change rapidly, regularly check the Victorian Department of Health and Human Services website for updates: www.dhhs.vic.gov.au/coronavirus.
ADA information for members at www.ada.org.au/Covid-19-Portal/Dental-Professionals.