Strategy for continuation of work during Cov-19

The purpose of the strategy is to save and preserve the life and health of people, while minimizing the negative economic consequences of the crisis, with minimal weight on the state budget.

The main idea is то divide the team and the patients into two major groups and to adapt different actions towards the two groups.

  • The two groups will be: A (active) and E (endangered):
  • The endangered group: elderly people with health issues, who have been recorded to have high mortality rate with Cov-10. The measures for them are focused towards maximum restriction of activity and contact with others, aiming to keep their health and life.
  • The active group: people in active age without any chronic diseases, kids and young people, who have been recorded to have low risk of fatal end. The measures for them are towards saving the economic activity of the state/country with really strict rules for restricting the spread of the virus.

For the employees:

Employees from group A:

  1. Normal working hours
    1. Provision of personal protective equipment(PPE), with high level of protection in conditions of aerosol (masks PPF3, goggles, protective clothes, stockings)
      1. The clothing should be long sleeved, it can be for single use.
      2. The cap is recommended.
      3. The protection of the eyes is from vital importance, and they should be protected not only frontally but also laterally.
      4. The goggles and helmets should be disinfected with alcohol 70%. The protection of the nose and mouth can be provided from surgical mask or masks with filters.
      5. The efficacy of protection from risks of surgical masks is documented and should be mandatory.
      6. It is necessary for the rules for using the PPEs to be followed.
      7. The virus remains in the air for a given time, so until you are in the contaminated zone you should never take off your PPEs. Right after use the PPEs are considered contaminated.
      8. One should be careful when taking off single use equipment and he/she should dispose it only in the designated places.
      9. One should follow normal hygiene rules (washing hands with soap and after using gloves for at least 20 seconds, or use hydroalcoholic solutions with at least 60%).
      10. One should avoid touching their eyes, mouth or nose with gloves or unwashed hands.
      11. The employees from group A, living with people from group E should be isolated from them (in another living space).

Employees from group E:

  1. Home office work if possible should be provided for them.

For patients:

  1. There should be different days for work with the patients from different groups A and E.
    1. Before making an appointment, some questions should be asked. The patients are warned to not come with companions, or if companions come they should wait outside, and they can be called when the manipulation is over.
    2. A declaration is filled in that the patient knows the working rules in situation of emergency situation in the country.
    3. The temperature is being measured with non-contact thermometer. If the temperature is higher than 37 degrees C, the appointment is cancelled.
    4. When the patient comes he is asked to wash his hands.
    5. Before the manipulation the patient is asked to wash his mouth with 0.2-1 iodopovidone; cetilpiridinchlorid 0.05-0.1%; 1% hydrogen peroxide, solutions containing chlorhexidine are considered non-effective.

Working process:

  1. While being in the waiting room the patients should wear mask. They should wash their hands or use disinfectant.
    1. The appointments are planned in such a manner that the patients have space between each other in the waiting room.
    2. All magazines and newspapers as well as kids’ toys, should be removed.
    3. The pens used by patients to fill in the needed documentation, are given to them as a gift.
    4. The preparation of the cabinets requires all necessary tools to be taken out on the plot. On the plots there should be only the necessary for the manipulation tools, everything else should be put on its place.
    5. The use of cofferdam is considered as possibility to reduce the aerosol in the mouth.
    6. After the end of the manipulation all surfaces in the cabinet are treated with disinfectant. The handpieces as well as the units are rubbed with disinfectant. The commodes, handles including the one of the doors are rubbed with disinfectant for surfaces. The floor is cleaned with floor disinfectant.
    7. If possible, provide ventilation in all spaces during the entire day.
    8. It is needed during the day the appliances for disinfection of the air with UV lights and 15% ozonation. During the night the ozonate of air should be on.
    9. Every hour the employee on front-office should clean with disinfectant the surfaces of their working space, including the computers and the cash registers.
    10. Every hour the employee of hygiene should clean the handles of the doors with disinfectant, as well the entire toilets and tables in the waiting room. Three times a day the floor should also be treated with disinfectant.
    11. The UV lamps in the compressor rooms should work all day.

Rules for using the room for rest:

  1. In the room for rest there cannot be more than two people at the same time.
    1. The used dishes should be washed only in the washing machine.
    2. The room should be used to make coffee, tea and other drinks, but the drinks should be drank outside of the rest room.
    3. Every hour the surfaces as well as the door handles should be disinfected.

Rules for orthodontic patients:

  1. The patients should have appointments in both cabinets, where the shortest appointment is 30 minutes.
  2. Patients for placement of braces – 90 minutes.
  3. The patients should be warned to not come with apparatuses in their mouths. They will be warned to come with brushed teeth, with their apparatuses cleaned before that with brush and soap. After that they should stay in a glass of water with a tablet of Protofix or Corega.
  4. The patient should come alone with no companion.
  5. If the patient is a child the companion/parent should wait in the car. If they have any questions they can call the doctor.

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